Provider Demographics
NPI:1255569851
Name:ROSSY-FULLANA, MARTA I I
Entity type:Individual
Prefix:
First Name:MARTA
Middle Name:I
Last Name:ROSSY-FULLANA
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:354 CALLE LUIS DE GONGORA
Mailing Address - Street 2:URB. EL SENORIAL
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-6908
Mailing Address - Country:US
Mailing Address - Phone:787-642-8901
Mailing Address - Fax:
Practice Address - Street 1:562 CALLE PEDRO BIGAY
Practice Address - Street 2:URB. BALDRICH
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-4032
Practice Address - Country:US
Practice Address - Phone:787-642-8901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-23
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3405103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool