Provider Demographics
NPI:1033219811
Name:ROSADO, IRWIN W
Entity Type:Individual
Prefix:MR
First Name:IRWIN
Middle Name:W
Last Name:ROSADO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 CALLE A
Mailing Address - Street 2:URB. LA VEGA
Mailing Address - City:VILLALBA
Mailing Address - State:PR
Mailing Address - Zip Code:00766-1716
Mailing Address - Country:US
Mailing Address - Phone:787-847-4272
Mailing Address - Fax:
Practice Address - Street 1:VA PONCE OUTPATIENT CLINIC
Practice Address - Street 2:PASEO DEL VETERANO 1010
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-2001
Practice Address - Country:US
Practice Address - Phone:787-812-3030
Practice Address - Fax:787-651-4321
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR047156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician