Provider Demographics
NPI:1326086000
Name:ROSALES-MEDINA, JOSE VICENTE (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:VICENTE
Last Name:ROSALES-MEDINA
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 826
Mailing Address - Street 2:
Mailing Address - City:BOQUERON
Mailing Address - State:PR
Mailing Address - Zip Code:00622-0826
Mailing Address - Country:US
Mailing Address - Phone:787-226-7855
Mailing Address - Fax:787-254-2144
Practice Address - Street 1:419 AVE HOSTOS
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-1519
Practice Address - Country:US
Practice Address - Phone:787-834-8800
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13236208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRH54521Medicare UPIN
PR0090304Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER