Healthcare Provider Details

I. General information

NPI: 1699054544
Provider Name (Legal Business Name): YELIANN MARIE ROSADO O.T.A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2011
Last Update Date: 08/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

759 AVE AVELINO VICENTE
SAN JUAN PR
00909-2538
US

IV. Provider business mailing address

BO CEIBA PAC HEIVA CARR 173 R 782 KM2 H1 INT
CIDRA PR
00739-7912
US

V. Phone/Fax

Practice location:
  • Phone: 787-644-9628
  • Fax: 787-724-5559
Mailing address:
  • Phone: 787-365-9893
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number1396871570
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: