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General NPI Number Information
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NPI Number | 1265842074
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Entity Type | Individual
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Provider Name | VICTOR M ROSARIO
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Gender | Male
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Dates
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Enumeration Date | 05/01/2014
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Last Update Date | 05/01/2014
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Provider Practice Location Address
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Address Line | 14567 MADISON AVE APT 103
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City | LAKEWOOD
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State | OH
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Zip | 44107-4337
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Country | US
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Telephone | 216-326-1219
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Fax |
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Provider Business Mailing Address
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Address Line | 14567 MADISON AVE APT 103
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City | LAKEWOOD
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State | OH
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Zip | 44107-4337
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Country | US
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Telephone | 216-326-1219
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number | 0092153
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License Number State | OH
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