1689078594 NPI number — JACQUELINE ROSADO

Table of content: JACQUELINE ROSADO (NPI 1689078594)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689078594 NPI number — JACQUELINE ROSADO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROSADO
Provider First Name:
JACQUELINE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689078594
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/30/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15009 CALLE UCAR
Provider Second Line Business Mailing Address:
PASEOS DE JACARANDA
Provider Business Mailing Address City Name:
SANTA ISABEL
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00757-9600
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-423-7515
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
COMUNIDAD CRISTINA
Provider Second Line Business Practice Location Address:
3 CALLE LAS GLADIOLAS
Provider Business Practice Location Address City Name:
JUANA DIAZ
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00795-9998
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
939-731-3024
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/21/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  1757 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1757 . This is a "LICENSE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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