MEDICARE: MS. MILDRED ROSADO-CANALES

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	1710I1003X	Independent Duty Medical Technicians

General Provider Information

NPI Number	:	1598062093
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MILDRED ROSADO-CANALES

Provider Business Mailing Address
First Line	:	PSC 94 BOX 826
Second Line	:
City	:	APO
State	:	AE
Zip	:	09824-0009
Country	:	US
Telephone Number	:	321-373-7868
Fax Number	:

Provider Business Practice Location Address
First Line	:	PSC 94 BOX 826
Second Line	:
City	:	APO
State	:	AE
Zip	:	09824-0009
Country	:	US
Telephone Number	:	321-373-7868
Fax Number	:

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

Provider Enumeration Date	:	02/17/2011
Last Update Date	:	06/07/2013

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