Provider Demographics
NPI:1316373111
Name:ROSARIO, EDINNETTE (MS-PHL)
Entity Type:Individual
Prefix:
First Name:EDINNETTE
Middle Name:
Last Name:ROSARIO
Suffix:
Gender:F
Credentials:MS-PHL
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 4960
Mailing Address - Street 2:PMB 119
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-4960
Mailing Address - Country:US
Mailing Address - Phone:787-243-6702
Mailing Address - Fax:
Practice Address - Street 1:AVE. AMERICO MIRANDA 1262
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-3307
Practice Address - Country:US
Practice Address - Phone:787-243-6702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-25
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1098235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist