Healthcare Provider Details

I. General information

NPI: 1265348197
Provider Name (Legal Business Name): MS. MARY ELEINE ROSADO MUNIZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB MANSION DEL LAGO # 86 COTO LAUREL
PONCE PR
00780
US

IV. Provider business mailing address

URB. MANSION DEL LAGO # 86 CALLE LAGO CERRILLOS COTO LA
PONCE PR
00780
US

V. Phone/Fax

Practice location:
  • Phone: 787-341-6211
  • Fax:
Mailing address:
  • Phone: 787-341-6211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number5800E
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: