Provider Demographics
NPI:1558858787
Name:ROSADO CARRION MEDICAL GROUP PSC
Entity Type:Organization
Organization Name:ROSADO CARRION MEDICAL GROUP PSC
Other - Org Name:ROSADO CARRION MEDICAL GROUP PSC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROSADO RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-904-3638
Mailing Address - Street 1:CALLE BOQUERON 31
Mailing Address - Street 2:VILLAS DE LA PLAYA
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00693
Mailing Address - Country:US
Mailing Address - Phone:787-904-3638
Mailing Address - Fax:
Practice Address - Street 1:CALLE BOQUERON 31
Practice Address - Street 2:VILLAS DE LA PLAYA
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693
Practice Address - Country:US
Practice Address - Phone:787-904-3638
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-13
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty