Provider Demographics
NPI:1780896662
Name:ROSADO RODRIGUEZ, AMARYLIS (MD)
Entity type:Individual
Prefix:DR
First Name:AMARYLIS
Middle Name:
Last Name:ROSADO RODRIGUEZ
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:#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:
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
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15519207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PREV591AMedicare PIN