Provider Demographics
NPI:1275689234
Name:ROSADO-MALDONADO, WILFREDO (OD)
Entity Type:Individual
Prefix:DR
First Name:WILFREDO
Middle Name:
Last Name:ROSADO-MALDONADO
Suffix:
Gender:M
Credentials:OD
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 2138
Mailing Address - Street 2:
Mailing Address - City:VEGA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00692-2138
Mailing Address - Country:US
Mailing Address - Phone:787-883-6406
Mailing Address - Fax:787-883-7142
Practice Address - Street 1:CALLE LUIS MUNOZ RIVERA 58-A
Practice Address - Street 2:
Practice Address - City:VEGA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00692
Practice Address - Country:US
Practice Address - Phone:787-883-6406
Practice Address - Fax:787-883-7142
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR336152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRU-62117Medicare UPIN
PR0058154Medicare ID - Type Unspecified