1760244248 NPI number — ROSAURA DOMENECH GUTIERREZ MSW

Table of content: ROSAURA DOMENECH GUTIERREZ MSW (NPI 1760244248)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760244248 NPI number — ROSAURA DOMENECH GUTIERREZ MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOMENECH GUTIERREZ
Provider First Name:
ROSAURA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760244248
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/31/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2044 CAMINO REAL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ISABELA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00662
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
939-339-2082
Provider Business Mailing Address Fax Number:
787-551-4119

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
BUEN SAMARITANO MEDICAL & PROFESSIONAL PLAZA
Provider Second Line Business Practice Location Address:
TERCER PISO SUITE 11
Provider Business Practice Location Address City Name:
AGUADILLA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-422-2595
Provider Business Practice Location Address Fax Number:
787-551-4119
Provider Enumeration Date:
01/29/2024

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  16206 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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