Basic Information
| Provider Information | |||||||||
| NPI: | 1366581118 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DE LOS SANTOS | ||||||||
| FirstName: | ROSANA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 120 NW 12TH ST | ||||||||
| Address2: | |||||||||
| City: | HOMESTEAD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330304222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7862431990 | ||||||||
| FaxNumber: | 7862439095 | ||||||||
| Practice Location | |||||||||
| Address1: | 1272 NW 119TH ST | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331673232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3056855688 | ||||||||
| FaxNumber: | 3056887995 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2007 | ||||||||
| LastUpdateDate: | 04/16/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | ME91435 | FL | Y | Allopathic & Osteopathic Physicians | General Practice | 207VG0400X | ME91435 | FL | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology |
ID Information
| ID | Type | State | Issuer | Description | ME91435 | 01 | FL | MEDICAL LICENSE | OTHER | 267763600 | 05 | FL | MEDICAID |