Provider Demographics
NPI:1194892653
Name:SOBRINO, ROSA M (DDS)
Entity type:Individual
Prefix:DR
First Name:ROSA
Middle Name:M
Last Name:SOBRINO
Suffix:
Gender:F
Credentials:DDS
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 1777
Mailing Address - Street 2:
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00785
Mailing Address - Country:US
Mailing Address - Phone:787-864-0615
Mailing Address - Fax:787-864-5606
Practice Address - Street 1:A CALIMANO #25 SUR
Practice Address - Street 2:ESQUINA E GONZALEZ
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00785
Practice Address - Country:US
Practice Address - Phone:787-864-0615
Practice Address - Fax:787-864-5606
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1956122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
041551OtherCRUZ AZUL
7850002OtherHUMANA HEALTH PLAN
26553OtherAMERICAN HEALTH PLAN
3209OtherINTERNATIONAL MEDICAL CAR
206111OtherPREFERRED
41797OtherTRIPLE S