Provider Demographics
NPI:1194312793
Name:ROSA, KARYSSA JOANDIS (MD)
Entity type:Individual
Prefix:MISS
First Name:KARYSSA
Middle Name:JOANDIS
Last Name:ROSA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 276
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:PR
Mailing Address - Zip Code:00751-0276
Mailing Address - Country:US
Mailing Address - Phone:787-558-7888
Mailing Address - Fax:787-824-7242
Practice Address - Street 1:BALDORIOTY ST 56
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:PR
Practice Address - Zip Code:00751
Practice Address - Country:US
Practice Address - Phone:787-558-7888
Practice Address - Fax:787-824-7242
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-29
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR22122208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice