Basic Information
| Provider Information | |||||||||
| NPI: | 1568431419 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROSA SOLA | ||||||||
| FirstName: | MABEL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1357 | ||||||||
| Address2: | |||||||||
| City: | CAGUAS | ||||||||
| State: | PR | ||||||||
| PostalCode: | 007261357 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7872862800 | ||||||||
| FaxNumber: | 7872862805 | ||||||||
| Practice Location | |||||||||
| Address1: | 790 BUENAVENTURA BLVD | ||||||||
| Address2: | |||||||||
| City: | KISSIMMEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347438128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4073449959 | ||||||||
| FaxNumber: | 4073449971 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2006 | ||||||||
| LastUpdateDate: | 12/06/2017 | ||||||||
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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 | 14932 | PR | N | Allopathic & Osteopathic Physicians | General Practice |
ID Information
| ID | Type | State | Issuer | Description | BR8465874 | 01 | FL | DEA | OTHER |