Provider Demographics
NPI:1922081611
Name:ROSA, JAIME (MD)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:
Last Name:ROSA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:442 CAMINO DEL SUSUA SABANERA DORADO
Mailing Address - Street 2:
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-4521
Mailing Address - Country:US
Mailing Address - Phone:787-740-7123
Mailing Address - Fax:787-740-7123
Practice Address - Street 1:BAYAMON MEDICAL PLZ
Practice Address - Street 2:SUITE 906
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-7200
Practice Address - Country:US
Practice Address - Phone:787-740-7123
Practice Address - Fax:787-740-7123
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-28
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR135312084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H82119Medicare UPIN
20342Medicare ID - Type Unspecified