MEDICARE: JACQUELINE ROSADO

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	103TC0700X	Clinical Psychologist	1757	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1757	OTHER	PR	LICENSE

General Provider Information

NPI Number	:	1689078594
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE ROSADO

Provider Business Mailing Address
First Line	:	15009 CALLE UCAR
Second Line	:	PASEOS DE JACARANDA
City	:	SANTA ISABEL
State	:	PR
Zip	:	00757-9600
Country	:	US
Telephone Number	:	787-423-7515
Fax Number	:

Provider Business Practice Location Address
First Line	:	COMUNIDAD CRISTINA
Second Line	:	3 CALLE LAS GLADIOLAS
City	:	JUANA DIAZ
State	:	PR
Zip	:	00795-9998
Country	:	US
Telephone Number	:	939-731-3024
Fax Number	:

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

Provider Enumeration Date	:	10/21/2014
Last Update Date	:	04/30/2025

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Directions to “ JACQUELINE ROSADO ” Practice Location

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