Provider Demographics
NPI:1518229848
Name:GAONA CADENA, ROSALBA (771235)
Entity Type:Individual
Prefix:MISS
First Name:ROSALBA
Middle Name:
Last Name:GAONA CADENA
Suffix:
Gender:F
Credentials:771235
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:382 WILLOW RD W
Mailing Address - Street 2:2D
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-7905
Mailing Address - Country:US
Mailing Address - Phone:347-881-8185
Mailing Address - Fax:
Practice Address - Street 1:382 WILLOW RD W
Practice Address - Street 2:2D
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-7905
Practice Address - Country:US
Practice Address - Phone:347-881-8185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY771235174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist