Healthcare Provider Details

I. General information

NPI: 1700420270
Provider Name (Legal Business Name): MRS. MARLYN ROSADO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MRS. MARLYN ROSADO

II. Dates (important events)

Enumeration Date: 10/29/2019
Last Update Date: 10/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE NUNEZ ROMEU #55
CAYEY PR
00736
US

IV. Provider business mailing address

CALLE NUNEZ ROMEU #55
CAYEY PR
00736
US

V. Phone/Fax

Practice location:
  • Phone: 787-738-1800
  • Fax: 787-738-1800
Mailing address:
  • Phone: 939-400-1441
  • Fax: 787-738-1800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374700000X
TaxonomyTechnician
License Number
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: