Provider Demographics
NPI:1962554402
Name:DE LA ROSA, NOEMI
Entity type:Individual
Prefix:
First Name:NOEMI
Middle Name:
Last Name:DE LA ROSA
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 1:1885 CALLE FRANCISCO ZUNIGA
Mailing Address - Street 2:FAIR VIEW
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-7629
Mailing Address - Country:US
Mailing Address - Phone:787-748-3266
Mailing Address - Fax:787-273-6115
Practice Address - Street 1:1785 CARR 21
Practice Address - Street 2:LAS LOMAS
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00921-3399
Practice Address - Country:US
Practice Address - Phone:787-782-9999
Practice Address - Fax:787-273-6115
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4485183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist