Provider Demographics
NPI:1790339489
Name:ROSAS SANTIAGO, PEDRO ENRIQUE
Entity Type:Individual
Prefix:
First Name:PEDRO
Middle Name:ENRIQUE
Last Name:ROSAS SANTIAGO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2822 N UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33322-2450
Mailing Address - Country:US
Mailing Address - Phone:754-223-2321
Mailing Address - Fax:954-252-4026
Practice Address - Street 1:5291 SW 14TH ST
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-5450
Practice Address - Country:US
Practice Address - Phone:786-447-1570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-31
Last Update Date:2022-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11003535363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily