Provider Demographics
NPI:1992542583
Name:MENA DE ROSARIO, KEILA MARIA
Entity type:Individual
Prefix:
First Name:KEILA
Middle Name:MARIA
Last Name:MENA DE ROSARIO
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 1:3535 KINGS COLLEGE PL APT 6C
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-1543
Mailing Address - Country:US
Mailing Address - Phone:646-925-7702
Mailing Address - Fax:
Practice Address - Street 1:1262 BOSTON RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-3541
Practice Address - Country:US
Practice Address - Phone:718-569-7929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-10
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY94614101163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse