Provider Demographics
NPI:1619277969
Name:CLINICA SANTA ROSA
Entity Type:Organization
Organization Name:CLINICA SANTA ROSA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRADORA
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:DEL C
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:MHSA
Authorized Official - Phone:787-864-0101
Mailing Address - Street 1:PO BOX 10008
Mailing Address - Street 2:
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00785-4008
Mailing Address - Country:US
Mailing Address - Phone:787-864-0101
Mailing Address - Fax:787-866-0489
Practice Address - Street 1:LOS VETERANOS AVE ROAD NO 3
Practice Address - Street 2:SALIDA HACIA ARROYO
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00784
Practice Address - Country:US
Practice Address - Phone:787-864-0101
Practice Address - Fax:787-866-0489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-02
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR39282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1336248947OtherNPI
PR1336248947Medicare Oscar/Certification