Provider Demographics
NPI:1437399029
Name:ROSADO, JULISSA
Entity Type:Individual
Prefix:
First Name:JULISSA
Middle Name:
Last Name:ROSADO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2070 3RD AVE
Mailing Address - Street 2:APT 14-G
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-2112
Mailing Address - Country:US
Mailing Address - Phone:212-533-0977
Mailing Address - Fax:
Practice Address - Street 1:2070 3RD AVE
Practice Address - Street 2:APT 14-G
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-2112
Practice Address - Country:US
Practice Address - Phone:212-533-0977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-23
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY263317164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse