Provider Demographics
NPI:1689361198
Name:ROSAS REHABILITATION PAIN AND SPORT INSTITUTE LLC
Entity Type:Organization
Organization Name:ROSAS REHABILITATION PAIN AND SPORT INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ATTENDING PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ODRICK
Authorized Official - Middle Name:ROBERTO
Authorized Official - Last Name:ROSAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-870-8403
Mailing Address - Street 1:PO BOX 1041
Mailing Address - Street 2:
Mailing Address - City:VEGA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00692-1041
Mailing Address - Country:US
Mailing Address - Phone:939-287-7553
Mailing Address - Fax:
Practice Address - Street 1:URB SAN FERNANDO A1 CALLE 1
Practice Address - Street 2:
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953-0467
Practice Address - Country:US
Practice Address - Phone:787-870-8403
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-24
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty