Healthcare Provider Details

I. General information

NPI: 1548642572
Provider Name (Legal Business Name): ANTHONY LEE ROSARIO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2015
Last Update Date: 06/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HC 2 BOX 10620
YAUCO PR
00698-9678
US

IV. Provider business mailing address

HC 2 BOX 10620
YAUCO PR
00698-9678
US

V. Phone/Fax

Practice location:
  • Phone: 787-226-0099
  • Fax:
Mailing address:
  • Phone: 787-226-0099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246W00000X
TaxonomyCardiology Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2471V0105X
TaxonomyVascular Sonography Radiologic Technologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2472E0500X
TaxonomyEEG Technician
License Number
License Number State

VIII. Authorized Official

Name: MR. ANTHONY LEE ROSARIO
Title or Position: TECHNOLOGYST
Credential:
Phone: 787-226-0099