Provider Demographics
NPI:1366639205
Name:ROSADO MEDINA, SANDRA I (MD)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:I
Last Name:ROSADO MEDINA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 CALLE REYNA MORA
Mailing Address - Street 2:HACIENDA EL PILAR
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953-9420
Mailing Address - Country:US
Mailing Address - Phone:787-399-9368
Mailing Address - Fax:
Practice Address - Street 1:CARR 861
Practice Address - Street 2:BO. PINAS SECTOR EL SIETE
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953-8528
Practice Address - Country:US
Practice Address - Phone:787-399-9368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-25
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16900208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice