Healthcare Provider Details

I. General information

NPI: 1265257646
Provider Name (Legal Business Name): JACQUELINE DEL ROSARIO PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2024
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11205 S DIXIE HWY STE 201
PINECREST FL
33156-4447
US

IV. Provider business mailing address

11205 S DIXIE HWY STE 201
PINECREST FL
33156-4447
US

V. Phone/Fax

Practice location:
  • Phone: 305-232-6003
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: