Provider Demographics
NPI:1013088442
Name:ROSARIO, FERNANDO LUIS (OD)
Entity Type:Individual
Prefix:DR
First Name:FERNANDO
Middle Name:LUIS
Last Name:ROSARIO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2292
Mailing Address - Street 2:
Mailing Address - City:COAMO
Mailing Address - State:PR
Mailing Address - Zip Code:00769-4292
Mailing Address - Country:US
Mailing Address - Phone:787-864-6884
Mailing Address - Fax:787-864-6884
Practice Address - Street 1:PLAZA GUAYAMA MALL #48
Practice Address - Street 2:SUITE R.D. 3 KM. 1.34.6
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00784-0000
Practice Address - Country:US
Practice Address - Phone:787-864-6884
Practice Address - Fax:787-864-6884
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR261152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist