Healthcare Provider Details

I. General information

NPI: 1306755731
Provider Name (Legal Business Name): JAHEILI M JUSINO ROSADO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

G11 CALLE 12
BAYAMON PR
00961-3670
US

IV. Provider business mailing address

G11 CALLE 12 REPARTO TERESITA
BAYAMON PR
00961-3670
US

V. Phone/Fax

Practice location:
  • Phone: 787-224-9187
  • Fax:
Mailing address:
  • Phone: 787-224-9187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number7967
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: