Provider Demographics
NPI:1831319128
Name:SANABRIA, ROWDY RAY
Entity Type:Individual
Prefix:
First Name:ROWDY
Middle Name:RAY
Last Name:SANABRIA
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:URB. VILLA AIDA CALLE 2 B-14
Mailing Address - Street 2:
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623
Mailing Address - Country:US
Mailing Address - Phone:787-519-2561
Mailing Address - Fax:
Practice Address - Street 1:URB. VILLA AIDA CALLE 2 B-14
Practice Address - Street 2:
Practice Address - City:CABO ROJO
Practice Address - State:PR
Practice Address - Zip Code:00623
Practice Address - Country:US
Practice Address - Phone:787-519-2561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-27
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2003-2353-P146L00000X
PR137571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic