1992845903 NPI number — MRS. WILMA AGOSTO ROSA RPH

Table of content: MRS. WILMA AGOSTO ROSA RPH (NPI 1992845903)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992845903 NPI number — MRS. WILMA AGOSTO ROSA RPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROSA
Provider First Name:
WILMA
Provider Middle Name:
AGOSTO
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RPH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROSA
Provider Other First Name:
WILMA
Provider Other Middle Name:
AGOSTO
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RPH
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1992845903
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 20122
Provider Second Line Business Mailing Address:
SAN JUAN
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00928-0122
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-757-6762
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
86 GERGTI RIO PIEDRAS
Provider Second Line Business Practice Location Address:
SAN JUAN
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00928-0122
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-757-6762
Provider Business Practice Location Address Fax Number:
787-772-9221
Provider Enumeration Date:
02/07/2007

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: 183500000X , with the licence number:  2287 , 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)

  • Identifier: 2287 . This is a "LIC DE PR" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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