Provider Demographics
NPI:1790209948
Name:CRESPO ROSA, ANA E (MT)
Entity Type:Individual
Prefix:MRS
First Name:ANA
Middle Name:E
Last Name:CRESPO ROSA
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE COLON #162
Mailing Address - Street 2:PO BOX 1092
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602
Mailing Address - Country:US
Mailing Address - Phone:787-868-6080
Mailing Address - Fax:787-551-3018
Practice Address - Street 1:CALLE COLON #162
Practice Address - Street 2:PO BOX 1092
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602
Practice Address - Country:US
Practice Address - Phone:787-868-6080
Practice Address - Fax:787-551-3018
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1739246QM0706X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1739OtherSTATE PRACTICE LICENCE NUMBER