Provider Demographics
NPI:1831293299
Name:ROSADO SANTA, MAYRA (DC)
Entity type:Individual
Prefix:
First Name:MAYRA
Middle Name:
Last Name:ROSADO SANTA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 70012
Mailing Address - Street 2:PMB 1182
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738-7012
Mailing Address - Country:US
Mailing Address - Phone:787-863-7691
Mailing Address - Fax:787-655-3782
Practice Address - Street 1:AVE CONQUISTADOR
Practice Address - Street 2:VISTAS DEL CONVENTO 2F22
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738
Practice Address - Country:US
Practice Address - Phone:787-863-7691
Practice Address - Fax:787-655-3782
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR317111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor