Provider Demographics
NPI:1013113802
Name:DE LA ROSA, NORMAN JAVIER (MD)
Entity Type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:JAVIER
Last Name:DE LA ROSA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:37 CALLE BELEN
Mailing Address - Street 2:ALTURAS DE SAN PATRICIO
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00968-3123
Mailing Address - Country:US
Mailing Address - Phone:787-792-4988
Mailing Address - Fax:
Practice Address - Street 1:1353 AVE. LUIS VIGOREAUX
Practice Address - Street 2:PMB 747
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00966-2700
Practice Address - Country:US
Practice Address - Phone:787-414-3942
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-27
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15439208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology