Provider Demographics
NPI:1477147320
Name:ROSA, JESSY (DC, NL)
Entity type:Individual
Prefix:DR
First Name:JESSY
Middle Name:
Last Name:ROSA
Suffix:
Gender:M
Credentials:DC, NL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 77 BOX 8582
Mailing Address - Street 2:
Mailing Address - City:VEGA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00692-9623
Mailing Address - Country:US
Mailing Address - Phone:787-346-1242
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA NUMERO 2, KM.40.2 BARRIO ALGARROBOS
Practice Address - Street 2:LOCAL # 6
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693
Practice Address - Country:US
Practice Address - Phone:787-600-7024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-22
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR183175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath