Provider Demographics
NPI:1851329486
Name:ROSARIO, CARMEN M (N/A)
Entity Type:Individual
Prefix:MS
First Name:CARMEN
Middle Name:M
Last Name:ROSARIO
Suffix:
Gender:F
Credentials:N/A
Other - Prefix:MRS
Other - First Name:IVELISSE
Other - Middle Name:
Other - Last Name:MALDONADO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:N/A
Mailing Address - Street 1:URB.SANTAJUANITA AQ
Mailing Address - Street 2:#28 AVENIDA LAUREL
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-4748
Mailing Address - Country:US
Mailing Address - Phone:787-740-2540
Mailing Address - Fax:787-780-6332
Practice Address - Street 1:URB.SANTAJUANITA AQ
Practice Address - Street 2:#28 AVE. LAUREL
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-4748
Practice Address - Country:US
Practice Address - Phone:787-740-2540
Practice Address - Fax:787-780-6332
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1212800001Medicare NSC