Healthcare Provider Details

I. General information

NPI: 1457045734
Provider Name (Legal Business Name): JERIEL GONZALEZ ROSADO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2023
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE. HOSTOS 410, CARRETERA 2, BO. SABALOS
MAYAGUEZ PR
00680
US

IV. Provider business mailing address

RR 5 BOX 6304
ANASCO PR
00610-9805
US

V. Phone/Fax

Practice location:
  • Phone: 787-652-9200
  • Fax:
Mailing address:
  • Phone: 787-519-0079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number17444-I
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: