Provider Demographics
NPI:1689886343
Name:ROSARIO, JESUS JOEL
Entity Type:Individual
Prefix:
First Name:JESUS
Middle Name:JOEL
Last Name:ROSARIO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CARRETERA 165 KM.10.5
Mailing Address - Street 2:BUZON 5085 BO. CONTONO SECTOR CIELITO
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953
Mailing Address - Country:US
Mailing Address - Phone:787-225-3422
Mailing Address - Fax:787-772-4560
Practice Address - Street 1:AVE. BARBOSA # 414
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00928
Practice Address - Country:US
Practice Address - Phone:787-763-7575
Practice Address - Fax:787-772-4560
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4067265172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver