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General NPI Number Information
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NPI Number | 1750793295
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Entity Type | Organization
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Legal Business Name | DRA. YESENIA E. JUSTINIANO ROSARIO CSP
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Dates
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Enumeration Date | 06/02/2014
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Last Update Date | 01/07/2015
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Provider Practice Location Address
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Address Line | 167 SANTIAGO RIERA PALMER
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City | MAYAGUEZ
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State | PR
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Zip | 00680-5036
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Country | US
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Telephone | 787-831-3270
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Fax |
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Provider Business Mailing Address
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Address Line | 167 SANTIAGO RIERA PALMER
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City | MAYAGUEZ
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State | PR
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Zip | 00680-5036
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. YESENIA E. JUSTINIANO ROSARIO
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Credential | M.D.
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Telephone | 787-317-7792
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | 17382
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License Number State | PR
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