Provider Demographics
NPI:1265498513
Name:ROSADO, HERIBERTO (MD)
Entity Type:Individual
Prefix:
First Name:HERIBERTO
Middle Name:
Last Name:ROSADO
Suffix:
Gender:M
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 176
Mailing Address - Street 2:
Mailing Address - City:NAGUABO
Mailing Address - State:PR
Mailing Address - Zip Code:00718-0176
Mailing Address - Country:US
Mailing Address - Phone:787-852-8248
Mailing Address - Fax:787-852-8248
Practice Address - Street 1:CENTRO SALUD SAN LORENZO
Practice Address - Street 2:
Practice Address - City:SAN LORENZO
Practice Address - State:PR
Practice Address - Zip Code:00754
Practice Address - Country:US
Practice Address - Phone:787-852-8248
Practice Address - Fax:787-852-8248
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7239208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0023779Medicare ID - Type Unspecified
PRI-49011Medicare UPIN