Healthcare Provider Details

I. General information

NPI: 1700532108
Provider Name (Legal Business Name): BILLY J ROSADO RIVERA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2022
Last Update Date: 08/16/2023
Certification Date: 08/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LEVITTOWN HF 16 CALLE LIZZIE GRAHAM
TOA BAJA PR
00949-2838
US

IV. Provider business mailing address

LEVITTOWN HF 16 CALLE LIZZIE GRAHAM
TOA BAJA PR
00949-2838
US

V. Phone/Fax

Practice location:
  • Phone: 787-795-2935
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number23357
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: