Provider Demographics
NPI:1184906620
Name:ROSARIO, AIXA M
Entity type:Individual
Prefix:
First Name:AIXA
Middle Name:M
Last Name:ROSARIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. EXT. SAN JOSE I5
Mailing Address - Street 2:
Mailing Address - City:AIBONITO
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00705
Mailing Address - Country:UM
Mailing Address - Phone:787-595-9720
Mailing Address - Fax:
Practice Address - Street 1:CALLE BARCELO
Practice Address - Street 2:
Practice Address - City:BARRANQUITAS
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00794
Practice Address - Country:UM
Practice Address - Phone:787-607-1687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-11
Last Update Date:2011-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3469103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling