Provider Demographics
NPI:1700300480
Name:ROSA, GRISELDA (OPTICIAN)
Entity Type:Individual
Prefix:
First Name:GRISELDA
Middle Name:
Last Name:ROSA
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 TRUNCADO STREET,
Mailing Address - Street 2:SUITE A122, PLAZA DEL NORTE
Mailing Address - City:HATILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00659
Mailing Address - Country:US
Mailing Address - Phone:787-663-1999
Mailing Address - Fax:
Practice Address - Street 1:506 CALLE TRUNCADO STE A122
Practice Address - Street 2:PLAZA DEL NORTE
Practice Address - City:HATILLO
Practice Address - State:PR
Practice Address - Zip Code:00659-2737
Practice Address - Country:US
Practice Address - Phone:787-880-3860
Practice Address - Fax:954-312-9316
Is Sole Proprietor?:No
Enumeration Date:2017-08-03
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1341156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician