Basic Information
Provider Information | |||||||||
NPI: | 1922084995 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ORSINI CHEVERE | ||||||||
FirstName: | ROSA | ||||||||
MiddleName: | E | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | B6 CALLE SANTA CATALINA | ||||||||
Address2: | PASEO SAN JUAN | ||||||||
City: | SAN JUAN | ||||||||
State: | PR | ||||||||
PostalCode: | 009266504 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7877480207 | ||||||||
FaxNumber: | 7877480936 | ||||||||
Practice Location | |||||||||
Address1: | 37 1/2 PONCE DE LEON AVE | ||||||||
Address2: | HOSPITAL AUXILIO MUTUO | ||||||||
City: | HATO REY | ||||||||
State: | PR | ||||||||
PostalCode: | 009171104 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7877582000 | ||||||||
FaxNumber: | 7877717872 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/21/2005 | ||||||||
LastUpdateDate: | 01/10/2017 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207U00000X | 8767 | PR | Y |   | Allopathic & Osteopathic Physicians | Nuclear Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 80783 | 01 | PR | SSS PROVIDER | OTHER |