Provider Demographics
NPI:1619042413
Name:OFTALMOLOGA CSP
Entity Type:Organization
Organization Name:OFTALMOLOGA CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSANA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSADO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-745-0115
Mailing Address - Street 1:201 AVE. GAUTIER BENITEZ SUITE 034
Mailing Address - Street 2:CONSOLIDATED MEDICAL PLAZA
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725
Mailing Address - Country:US
Mailing Address - Phone:787-745-0115
Mailing Address - Fax:787-745-0115
Practice Address - Street 1:201 AVE. GAUTIER BENITEZ OFICINA 404
Practice Address - Street 2:CONSOLIDATED MEDICAL PLAZA
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-745-0115
Practice Address - Fax:787-745-0115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR013626174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty