Provider Demographics
NPI:1679739239
Name:MALDONADO ESPARRA, ROSA G
Entity Type:Individual
Prefix:MRS
First Name:ROSA
Middle Name:G
Last Name:MALDONADO ESPARRA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PMB 238 PO BOX 2500
Mailing Address - Street 2:
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00977-2500
Mailing Address - Country:US
Mailing Address - Phone:787-518-4561
Mailing Address - Fax:787-760-4862
Practice Address - Street 1:URB ENCANTADA PACIFICA P-G 72
Practice Address - Street 2:
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976
Practice Address - Country:US
Practice Address - Phone:787-518-4561
Practice Address - Fax:787-760-4862
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-04
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier