Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | DN20791 | FL |
NPI | 1063829877 |
---|---|
Provider Name | Jesse O. Rosario |
First Address | Katy, TX 77449-4610 |
Second Address | Orlando, FL 32835-3291 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2014 |
Last Update Date | 19/06/2021 |