Provider Demographics
NPI:1023236858
Name:ROSA, MARTIN (MD)
Entity type:Individual
Prefix:DR
First Name:MARTIN
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:STREET VISTA DEL MORRO #120
Mailing Address - Street 2:PANORAMA VILLAGE
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00957
Mailing Address - Country:US
Mailing Address - Phone:787-797-6556
Mailing Address - Fax:
Practice Address - Street 1:120 VISTA DEL MORRO
Practice Address - Street 2:PANORAMA VILLAGE
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00957-4401
Practice Address - Country:US
Practice Address - Phone:787-797-6556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10162208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice