Healthcare Provider Details

I. General information

NPI: 1922993450
Provider Name (Legal Business Name): LUIS A ROSARIO ED.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2025
Last Update Date: 06/13/2025
Certification Date: 06/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

429 CALLE LOS PINOS APT 901
SAN JUAN PR
00917-3456
US

IV. Provider business mailing address

429 CALLE LOS PINOS APT 901
SAN JUAN PR
00917-3456
US

V. Phone/Fax

Practice location:
  • Phone: 787-640-5686
  • Fax: --
Mailing address:
  • Phone: 787-640-5686
  • Fax: --

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number00373
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: