Provider Demographics
NPI:1356328561
Name:REY LABORDE, ROSARIO (MD)
Entity type:Individual
Prefix:
First Name:ROSARIO
Middle Name:
Last Name:REY LABORDE
Suffix:
Gender:F
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:URB PLAZA DE LA FUENTE
Mailing Address - Street 2:1199 CALLE BRAZIL
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953-0000
Mailing Address - Country:US
Mailing Address - Phone:787-903-1444
Mailing Address - Fax:
Practice Address - Street 1:HOSPITAL PAVIA
Practice Address - Street 2:CALLE PROFESOR AUGUSTO # 1462
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00910-0000
Practice Address - Country:US
Practice Address - Phone:787-641-1616
Practice Address - Fax:787-728-2641
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-29
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR016121208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0023738Medicare PIN