Provider Demographics
NPI:1396816062
Name:MICHEL, ROSA LUZ (MD)
Entity Type:Individual
Prefix:MRS
First Name:ROSA
Middle Name:LUZ
Last Name:MICHEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 SEVERIANO CUEVAS
Mailing Address - Street 2:SUITE 1
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00603-5703
Mailing Address - Country:US
Mailing Address - Phone:787-891-7080
Mailing Address - Fax:787-891-7080
Practice Address - Street 1:19 SEVERIANO CUEVAS
Practice Address - Street 2:SUITE 1
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603-5703
Practice Address - Country:US
Practice Address - Phone:787-891-7080
Practice Address - Fax:787-891-7080
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8465208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
E81615Medicare UPIN
PR0080170Medicare ID - Type Unspecified