Healthcare Provider Details

I. General information

NPI: 1508002395
Provider Name (Legal Business Name): YESENIA E JUSTINIANO ROSARIO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2008
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 SAINT JOHNS MEDICAL PARK DR
ST AUGUSTINE FL
32086-5298
US

IV. Provider business mailing address

48 ZEBULAHS TRL
PALM COAST FL
32164-5260
US

V. Phone/Fax

Practice location:
  • Phone: 904-823-3301
  • Fax: 904-823-3328
Mailing address:
  • Phone: 787-317-7792
  • Fax: 787-831-3270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number17382
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: