MEDICARE: JASMARY LOPEZ ROSADO MD

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	24735	PR

General Provider Information

NPI Number	:	1568292753
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASMARY LOPEZ ROSADO MD

Provider Business Mailing Address
First Line	:	URB EL MAESTRO B12
Second Line	:	CALLE 3
City	:	CAMUY
State	:	PR
Zip	:	00627
Country	:	US
Telephone Number	:	787-204-9746
Fax Number	:

Provider Business Practice Location Address
First Line	:	55 CALLE PALMA
Second Line	:
City	:	ARECIBO
State	:	PR
Zip	:	00612-4526
Country	:	US
Telephone Number	:	787-650-1031
Fax Number	:

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

Provider Enumeration Date	:	08/03/2024
Last Update Date	:	03/18/2026

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