Provider Demographics
NPI:1598062093
Name:ROSADO-CANALES, MILDRED
Entity Type:Individual
Prefix:MS
First Name:MILDRED
Middle Name:
Last Name:ROSADO-CANALES
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:PSC 94 BOX 826
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09824-0009
Mailing Address - Country:US
Mailing Address - Phone:321-373-7868
Mailing Address - Fax:
Practice Address - Street 1:PSC 94 BOX 826
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09824-0009
Practice Address - Country:US
Practice Address - Phone:321-373-7868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-17
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians