Healthcare Provider Details

I. General information

NPI: 1982326187
Provider Name (Legal Business Name): MISS JESSICA FELICIANO ROSADO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2022
Last Update Date: 09/14/2022
Certification Date: 09/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BO COTO CALLE DEL PARQUE 21
ISABELA PR
00662
US

IV. Provider business mailing address

BO COTO CALLE DEL PARQUE 21
ISABELA PR
00662
US

V. Phone/Fax

Practice location:
  • Phone: 787-420-6240
  • Fax:
Mailing address:
  • Phone: 787-420-6240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number13960
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: