MEDICARE: ROSARIO REY LABORDE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	016121	PR

General Provider Information

NPI Number	:	1356328561
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSARIO REY LABORDE M.D.

Provider Business Mailing Address
First Line	:	URB PLAZA DE LA FUENTE
Second Line	:	1199 CALLE BRAZIL
City	:	TOA ALTA
State	:	PR
Zip	:	00953-0000
Country	:	US
Telephone Number	:	787-903-1444
Fax Number	:

Provider Business Practice Location Address
First Line	:	HOSPITAL PAVIA
Second Line	:	CALLE PROFESOR AUGUSTO # 1462
City	:	SAN JUAN
State	:	PR
Zip	:	00910-0000
Country	:	US
Telephone Number	:	787-641-1616
Fax Number	:	787-728-2641

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/29/2005
Last Update Date	:	01/30/2012

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