Provider Demographics
NPI:1306027230
Name:ROSARIO, JIMMY
Entity Type:Individual
Prefix:
First Name:JIMMY
Middle Name:
Last Name:ROSARIO
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:PO BOX 1368
Mailing Address - Street 2:
Mailing Address - City:OROCOVIS
Mailing Address - State:PR
Mailing Address - Zip Code:00720-1368
Mailing Address - Country:US
Mailing Address - Phone:787-375-0169
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA 155 BO FRANQUES
Practice Address - Street 2:SECTOR TORRECILLAS
Practice Address - City:MOROVIS
Practice Address - State:PR
Practice Address - Zip Code:00687
Practice Address - Country:US
Practice Address - Phone:787-375-0169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-20
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRTC AMB 4943416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport