Healthcare Provider Details

I. General information

NPI: 1215554381
Provider Name (Legal Business Name): JAMIE ALEXSANDER ROSADO-ALICEA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2020
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8169 CALLE CONCORDIA
PONCE PR
00717-1554
US

IV. Provider business mailing address

5421 CALLE GUABAIRO
PONCE PR
00728-3412
US

V. Phone/Fax

Practice location:
  • Phone: 787-605-4250
  • Fax: 781-998-8497
Mailing address:
  • Phone:
  • Fax: 781-998-8497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number022804
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: