Provider Demographics
NPI:1073847711
Name:ROSA-MORALES, AWILDA
Entity type:Individual
Prefix:MS
First Name:AWILDA
Middle Name:
Last Name:ROSA-MORALES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC-02 BOX 8298
Mailing Address - Street 2:
Mailing Address - City:QUEBRADILLAS
Mailing Address - State:PR
Mailing Address - Zip Code:00678-9802
Mailing Address - Country:US
Mailing Address - Phone:787-466-1967
Mailing Address - Fax:787-830-1654
Practice Address - Street 1:HC-02 BOX 8298
Practice Address - Street 2:
Practice Address - City:QUEBRADILLAS
Practice Address - State:PR
Practice Address - Zip Code:00678-9802
Practice Address - Country:US
Practice Address - Phone:787-466-1967
Practice Address - Fax:787-830-1654
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-29
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR679235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist