Provider Demographics
NPI:1619175437
Name:ROSARIO, RUBY YANINA
Entity Type:Individual
Prefix:
First Name:RUBY
Middle Name:YANINA
Last Name:ROSARIO
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:CALLE FRANCISCO CANALES ROMAN #19
Mailing Address - Street 2:
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949
Mailing Address - Country:US
Mailing Address - Phone:787-794-2473
Mailing Address - Fax:
Practice Address - Street 1:B35 CALLE 6
Practice Address - Street 2:URN SAN FERNANDO
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953-2205
Practice Address - Country:US
Practice Address - Phone:787-870-2935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6093183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician