Provider Demographics
NPI:1710168455
Name:ROSARIO, EDWIN
Entity Type:Individual
Prefix:
First Name:EDWIN
Middle Name:
Last Name:ROSARIO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ROSARIO
Other - Middle Name:MEDICAL
Other - Last Name:TRANSPORT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:HC 56 BOX 34266
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-9772
Mailing Address - Country:US
Mailing Address - Phone:939-644-6709
Mailing Address - Fax:787-818-0429
Practice Address - Street 1:CARR 417 KM 25.5 INT
Practice Address - Street 2:BO. MALPASO
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602
Practice Address - Country:US
Practice Address - Phone:939-644-6709
Practice Address - Fax:787-818-0429
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-23
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRP1377146L00000X
PRTC AMB 4803416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic