Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 261 | PR |
NPI | 1013088442 |
---|---|
Provider Name | Dr. Fernando Luis Rosario |
First Address | Coamo, PR 00769-4292 |
Second Address | Guayama, PR 00784-0000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2006 |
Last Update Date | 08/07/2007 |