Provider Demographics
NPI:1780146274
Name:ROSADO, MYRTELINA
Entity type:Individual
Prefix:
First Name:MYRTELINA
Middle Name:
Last Name:ROSADO
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:A3 CALLE ARACIBO
Mailing Address - Street 2:
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976-3503
Mailing Address - Country:US
Mailing Address - Phone:787-755-2261
Mailing Address - Fax:
Practice Address - Street 1:12 CALLE MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976-5914
Practice Address - Country:US
Practice Address - Phone:787-761-0210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-03
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2910183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1541972OtherDRVER LICENSE
PR1541972OtherDRIVER LICENSE
PR2910OtherPHARMACIST LICENSE