Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 14501 | PR |
NPI | 1013035013 |
---|---|
Provider Name | Jessica Rosario |
First Address | Canovanas, PR 00729-0239 |
Second Address | Santurce, PR 00909 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2007 |
Last Update Date | 08/07/2007 |