Provider Demographics
NPI:1952820334
Name:ASTACIO CONTRERAS, ROSAURA (PA-C)
Entity Type:Individual
Prefix:MS
First Name:ROSAURA
Middle Name:
Last Name:ASTACIO CONTRERAS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:ROSAURA
Other - Middle Name:
Other - Last Name:ASTACIO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1488 AMSTERDAM AVE APT 2C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10031-8945
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1901 1ST AVE RM 2A23
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-7404
Practice Address - Country:US
Practice Address - Phone:212-423-6464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-16
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021107-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant