Basic Information
| Provider Information | |||||||||
| NPI: | 1447699020 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HADDOCK-DE-JESUS | ||||||||
| FirstName: | ROSA | ||||||||
| MiddleName: | L. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | HC 2 BOX 14772 | ||||||||
| Address2: | |||||||||
| City: | GURABO | ||||||||
| State: | PR | ||||||||
| PostalCode: | 007789808 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7876880691 | ||||||||
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| Practice Location | |||||||||
| Address1: | HOSPITAL PEDIATRICO DR ANTONIO ORTIZ | ||||||||
| Address2: | BO. MONACILLOS ST. 22 PUERTO RICO MEDICAL CENTER | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009350001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877773535 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2013 | ||||||||
| LastUpdateDate: | 06/17/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | 4621798 | PR | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.