Healthcare Provider Details

I. General information

NPI: 1093977977
Provider Name (Legal Business Name): MARISOL RODRIGUEZ ROSADO OT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2008
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 BLVD SAGRADO CORAZON PDA 26 1/2
SAN JUAN PR
00909-3333
US

IV. Provider business mailing address

PO BOX 1431
COROZAL PR
00783-1431
US

V. Phone/Fax

Practice location:
  • Phone: 787-403-7557
  • Fax:
Mailing address:
  • Phone: 787-450-4349
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number000789
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: