Provider Demographics
NPI:1932278280
Name:ROSADO MAYSONET, IGNERYS
Entity Type:Individual
Prefix:
First Name:IGNERYS
Middle Name:
Last Name:ROSADO MAYSONET
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:RR 11 BOX 4003
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-9701
Mailing Address - Country:US
Mailing Address - Phone:787-661-6635
Mailing Address - Fax:787-258-7021
Practice Address - Street 1:CALLE MIGUEL CASILLAS
Practice Address - Street 2:ESQUINA MUNOZ MARIN LOCAL # 1
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:787-661-6635
Practice Address - Fax:787-285-8811
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15436208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR22984Medicare PIN