Healthcare Provider Details

I. General information

NPI: 1497679674
Provider Name (Legal Business Name): FERNANDO DIAZ ROSADO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2026
Last Update Date: 08/08/2026
Certification Date: 08/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

I4 CALLE 4 URB SYLVIA
COROZAL PR
00783-2338
US

IV. Provider business mailing address

I4 CALLE 4 URB SYLVIA
COROZAL PR
00783-2338
US

V. Phone/Fax

Practice location:
  • Phone: 787-217-4862
  • Fax:
Mailing address:
  • Phone: 787-217-4862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number8389
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: