MEDICARE: GLADYNETTE ROSARIO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	16005	PR

General Provider Information

NPI Number	:	1205822731
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLADYNETTE ROSARIO M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1893
Second Line	:
City	:	CAROLINA
State	:	PR
Zip	:	00984-1893
Country	:	US
Telephone Number	:	787-769-6684
Fax Number	:

Provider Business Practice Location Address
First Line	:	GALERIAS DE ESCORIAL SHOPP. CENTER
Second Line	:	5725 BLVD. MEDIA LUNA SUITE 5
City	:	CAROLINA
State	:	PR
Zip	:	00987-3515
Country	:	US
Telephone Number	:	787-579-6490
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	03/31/2016

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