1649401175 NPI number — MARIGLORY ROSA PSY.D.

Table of content: MARIGLORY ROSA PSY.D. (NPI 1649401175)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649401175 NPI number — MARIGLORY ROSA PSY.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROSA
Provider First Name:
MARIGLORY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PSY.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649401175
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/31/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
COND. COLINA REAL, AVE. FELISA R. DE GAUTIER
Provider Second Line Business Mailing Address:
APT 301
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00926
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-690-9040
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12 AVE ALEJANDRINO
Provider Second Line Business Practice Location Address:
URB. VILLA CLEMENTINA
Provider Business Practice Location Address City Name:
GUAYNABO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00969-4712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-690-9040
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/31/2009

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: 103TC0700X , with the licence number:  2147 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com