Provider Demographics
NPI:1699352302
Name:ROLON ROSADO, VIVIANA (LMT)
Entity Type:Individual
Prefix:
First Name:VIVIANA
Middle Name:
Last Name:ROLON ROSADO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 CARR 831 APT 1931
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-9558
Mailing Address - Country:US
Mailing Address - Phone:787-501-7311
Mailing Address - Fax:
Practice Address - Street 1:1000 CARR 831 APT 1931
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-9558
Practice Address - Country:US
Practice Address - Phone:787-501-7311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-27
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR923225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty