Provider Demographics
NPI:1700165941
Name:ROSARIO, CARLOS JAVIER (OPTICAL LAB)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:JAVIER
Last Name:ROSARIO
Suffix:
Gender:M
Credentials:OPTICAL LAB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:AVE. LUIS MUNOZ MARIN 0-13
Mailing Address - Street 2:VILLA CARMEN
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725
Mailing Address - Country:US
Mailing Address - Phone:787-469-2753
Mailing Address - Fax:
Practice Address - Street 1:13 AVE LUIS MUNOZ MARIN
Practice Address - Street 2:VILLA CARMEN
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-2000
Practice Address - Country:US
Practice Address - Phone:787-469-2753
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-05
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRN/A247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other