Provider Demographics
NPI:1295778355
Name:ROSSO QUEVEDO, ROBERTO (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:
Last Name:ROSSO QUEVEDO
Suffix:
Gender:M
Credentials:MD
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 364422
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-4422
Mailing Address - Country:US
Mailing Address - Phone:787-385-4924
Mailing Address - Fax:787-771-5151
Practice Address - Street 1:1122 CALLE 56 SE
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-2727
Practice Address - Country:US
Practice Address - Phone:787-771-5151
Practice Address - Fax:787-761-0613
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14284208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRH68430Medicare UPIN
PR0021045Medicare ID - Type Unspecified