Provider Demographics
NPI:1205822731
Name:ROSARIO, GLADYNETTE (MD)
Entity Type:Individual
Prefix:
First Name:GLADYNETTE
Middle Name:
Last Name:ROSARIO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1893
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00984-1893
Mailing Address - Country:US
Mailing Address - Phone:787-769-6684
Mailing Address - Fax:
Practice Address - Street 1:GALERIAS DE ESCORIAL SHOPP. CENTER
Practice Address - Street 2:5725 BLVD. MEDIA LUNA SUITE 5
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00987-3515
Practice Address - Country:US
Practice Address - Phone:787-579-6490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16005208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice