Provider Information for 1588214753
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REBECCA PENTA ROSE
Sex: Female
NPI: 1588214753
Last Updated: 2024-09-03
Certification Date: 2024-09-03
Certification Date: 2024-09-03
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1588214753 | ||||||||
| Enumeration Date | 2019-09-18 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 4706 NW 40TH TER GAINESVILLE, FL 32606-4444 United States Phone: | Fax: | ||||||||
| Primary Practice Address | 1901 NE 9TH ST GAINESVILLE, FL 32609-3736 United States Phone: 518-860-2689 | Fax: | ||||||||
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