Provider Demographics
NPI:1750946489
Name:RONCANCIO REY, ROSSY MARYORY (MD)
Entity type:Individual
Prefix:
First Name:ROSSY
Middle Name:MARYORY
Last Name:RONCANCIO REY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:513 BLVD MEDIA LUNA APT 1331
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987-5057
Mailing Address - Country:US
Mailing Address - Phone:939-254-0384
Mailing Address - Fax:
Practice Address - Street 1:CONCILIO DE SALUD INTEGRAL DE LOIZA
Practice Address - Street 2:CARRETERA 188 INT. #187
Practice Address - City:LOIZA
Practice Address - State:PR
Practice Address - Zip Code:00772
Practice Address - Country:US
Practice Address - Phone:787-876-7415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-08
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PR36063R207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program