Provider Demographics
NPI:1366818932
Name:ROSARIO, JETSYBELL (PHL)
Entity Type:Individual
Prefix:
First Name:JETSYBELL
Middle Name:
Last Name:ROSARIO
Suffix:
Gender:F
Credentials:PHL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:FF1 CALLE 18, AVE TENIENTE NELSON MARTINEZ
Mailing Address - Street 2:ALTURAS DE FLAMBOYAN
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956
Mailing Address - Country:US
Mailing Address - Phone:787-487-8006
Mailing Address - Fax:
Practice Address - Street 1:FF1 CALLE 18, AVE TENIENTE NELSON MARTINEZ
Practice Address - Street 2:ALTURAS DE FLAMBOYAN
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956
Practice Address - Country:US
Practice Address - Phone:787-487-8006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-18
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR003029235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist