MEDICARE: MR. GILBERTO J ROSARIO LND, ISAK 1, EDPR

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	133VN1006X	Metabolic Nutrition Registered Dietitian	1700	PR

General Provider Information

NPI Number	:	1487176681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GILBERTO J ROSARIO LND, ISAK 1, EDPR

Provider Business Mailing Address
First Line	:	1933 CALLE M MALDONADO
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00926-7749
Country	:	US
Telephone Number	:	787-367-2037
Fax Number	:

Provider Business Practice Location Address
First Line	:	1777 CARR 844
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00926-4434
Country	:	US
Telephone Number	:	787-748-9955
Fax Number	:

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

Provider Enumeration Date	:	07/10/2017
Last Update Date	:	07/10/2017

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