1043064561 NPI number — ROSEWYNDA DE SAN JOSE SANTOS RN

Table of content: ROSEWYNDA DE SAN JOSE SANTOS RN (NPI 1043064561)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043064561 NPI number — ROSEWYNDA DE SAN JOSE SANTOS RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SANTOS
Provider First Name:
ROSEWYNDA
Provider Middle Name:
DE SAN JOSE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DE SAN JOSE
Provider Other First Name:
ROSEWYNDA
Provider Other Middle Name:
ARCE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1043064561
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/12/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
498 CHALAN PALOSYO
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AGANA HEIGHTS
Provider Business Mailing Address State Name:
GU
Provider Business Mailing Address Postal Code:
96910-6427
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
671-475-5760
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
498 CHALAN PALOSYO
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AGANA HEIGHTS
Provider Business Practice Location Address State Name:
GU
Provider Business Practice Location Address Postal Code:
96910-6427
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
671-475-5760
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/12/2024

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  RX0400 , registered in the state of GU ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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