Healthcare Provider Details

I. General information

NPI: 1437352143
Provider Name (Legal Business Name): KATYNA ROSARIO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2007
Last Update Date: 05/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 N 12TH AVE BLDG B
ARCADIA FL
34266-8752
US

IV. Provider business mailing address

PO BOX 29134 PSIQUIATRIA RCM
SAN JUAN PR
00929-0134
US

V. Phone/Fax

Practice location:
  • Phone: 239-936-5250
  • Fax: 239-936-9970
Mailing address:
  • Phone: 787-522-8280
  • Fax: 787-522-8274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number20586
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number20586
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: