Provider Demographics
NPI:1689361206
Name:OSTEICOECHEA R, ROSA VIRGINIA
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:VIRGINIA
Last Name:OSTEICOECHEA R
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 1:11528 NW 84TH ST
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-1826
Mailing Address - Country:US
Mailing Address - Phone:305-905-3589
Mailing Address - Fax:
Practice Address - Street 1:JESSIE TRICE COMMUNITY HEALTH CENTER
Practice Address - Street 2:5361 NW 22ND AVE
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33142
Practice Address - Country:US
Practice Address - Phone:305-637-6400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-24
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program