Provider Demographics
NPI:1437480175
Name:ROSADO, MINERVA (MA)
Entity Type:Individual
Prefix:MRS
First Name:MINERVA
Middle Name:
Last Name:ROSADO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P-18 CALLE 11
Mailing Address - Street 2:URB. DOS RIOS
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949
Mailing Address - Country:US
Mailing Address - Phone:787-503-2899
Mailing Address - Fax:
Practice Address - Street 1:CARR 167 # KM14.6
Practice Address - Street 2:BO. BUENA VISTA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-4477
Practice Address - Country:US
Practice Address - Phone:787-503-2899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-20
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3669103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist