Provider Demographics
NPI:1912291733
Name:ROSADO, JOSE DAVID
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:DAVID
Last Name:ROSADO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MUNOZ RIVERA AVE. 218
Mailing Address - Street 2:
Mailing Address - City:CAMUY
Mailing Address - State:PR
Mailing Address - Zip Code:00627-0826
Mailing Address - Country:US
Mailing Address - Phone:787-646-8704
Mailing Address - Fax:
Practice Address - Street 1:129 STREET SAN LUIS AVE.
Practice Address - Street 2:ASSMCA-ARECIBO
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00613-9550
Practice Address - Country:US
Practice Address - Phone:787-878-3552
Practice Address - Fax:787-879-8633
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-09
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR21512164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse