Provider Demographics
NPI:1619968575
Name:ROSA-MENDEZ, ELIAS RUFO (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIAS
Middle Name:RUFO
Last Name:ROSA-MENDEZ
Suffix:
Gender:M
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:PO BOX 195402
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-5402
Mailing Address - Country:US
Mailing Address - Phone:787-767-5580
Mailing Address - Fax:
Practice Address - Street 1:313 AVE FONT MARTELO
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-3204
Practice Address - Country:US
Practice Address - Phone:787-852-1730
Practice Address - Fax:787-852-1730
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRPR 2736207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0092678Medicare ID - Type Unspecified
D08617Medicare UPIN