Healthcare Provider Details

I. General information

NPI: 1922158195
Provider Name (Legal Business Name): MR. HECTOR JULIO ROSARIO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 07/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5285 62ND ST N # 222
KENNETH CITY FL
33709-3338
US

IV. Provider business mailing address

5285 62ND ST N # 222
KENNETH CITY FL
33709-3338
US

V. Phone/Fax

Practice location:
  • Phone: 727-641-2687
  • Fax:
Mailing address:
  • Phone: 727-641-2687
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: