Healthcare Provider Details

I. General information

NPI: 1558336537
Provider Name (Legal Business Name): DOMINGO J ROSARIO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3851 ROGER BROOKE DRIVE, MCHE-QD (CREDS) FORT SAM HOUSTON
SAN ANTONIO TX
78234-6200
US

IV. Provider business mailing address

1983 OAKWELL FARMS PKWY # 1804
SAN ANTONIO TX
78218-1724
US

V. Phone/Fax

Practice location:
  • Phone: 210-916-5550
  • Fax:
Mailing address:
  • Phone: 210-831-2275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number01060799A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: