Provider Demographics
NPI:1770733149
Name:DR AMARYLIS ROSADO AND ASSOCIATES INC
Entity type:Organization
Organization Name:DR AMARYLIS ROSADO AND ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AMARYLIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSADO RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-802-2626
Mailing Address - Street 1:#387 CALLE VERSALLES
Mailing Address - Street 2:URB. VILLAS REALES
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-0000
Mailing Address - Country:US
Mailing Address - Phone:787-802-2626
Mailing Address - Fax:787-870-2781
Practice Address - Street 1:CARR. 159 KM 15.4
Practice Address - Street 2:LOCAL 308 PLAZA DEL CARMEN
Practice Address - City:COROZAL
Practice Address - State:PR
Practice Address - Zip Code:00783-0000
Practice Address - Country:US
Practice Address - Phone:787-802-2626
Practice Address - Fax:787-870-2781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-23
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15519207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR15519OtherLICENSE