Provider Demographics
NPI:1205210549
Name:ROSADO, RAFAEL (LPN)
Entity Type:Individual
Prefix:MR
First Name:RAFAEL
Middle Name:
Last Name:ROSADO
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:MR
Other - First Name:RAFAEL
Other - Middle Name:
Other - Last Name:ROSDAO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:2248 RIVER PARK CIR
Mailing Address - Street 2:APT 617
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32817-4870
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:407-385-7125
Practice Address - Street 1:2248 RIVER PARK CIR
Practice Address - Street 2:APT 617
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32817-4870
Practice Address - Country:US
Practice Address - Phone:407-385-7125
Practice Address - Fax:407-385-7125
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-16
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN1174731164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse