Provider Demographics
NPI:1386750743
Name:ROSA, PERLA (OD)
Entity type:Individual
Prefix:
First Name:PERLA
Middle Name:
Last Name:ROSA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100-CALLE FONT MARTELO STE 320
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00791-3926
Mailing Address - Country:US
Mailing Address - Phone:787-850-3485
Mailing Address - Fax:787-850-3485
Practice Address - Street 1:100-CALLE FONT MARTELO STE 320
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-3926
Practice Address - Country:US
Practice Address - Phone:787-850-3485
Practice Address - Fax:787-850-3485
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR526152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR660427481 HROtherCOSVI LENTES
PR660628475OtherMCS
PR7910104OtherHUMANA
PR100656OtherCRUZ AZUL
PRA044OtherINTERNATIONAL MEDICAL CAR
PR068-526OtherGLOBAL HEALTH