Provider Demographics
NPI:1437783214
Name:ROSA, SALENA (COSMETOLOGIST)
Entity Type:Individual
Prefix:
First Name:SALENA
Middle Name:
Last Name:ROSA
Suffix:
Gender:F
Credentials:COSMETOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7808 SARAH LN APT 404
Mailing Address - Street 2:
Mailing Address - City:JESSUP
Mailing Address - State:MD
Mailing Address - Zip Code:20794-3978
Mailing Address - Country:US
Mailing Address - Phone:917-434-3397
Mailing Address - Fax:
Practice Address - Street 1:10250 BALTIMORE AVE STE 104
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:MD
Practice Address - Zip Code:20740-4202
Practice Address - Country:US
Practice Address - Phone:301-836-1977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-02
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYAEC-16-003309224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist