Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 047 | PR |
NPI | 1033219811 |
---|---|
Provider Name | Mr. Irwin W Rosado |
First Address | Villalba, PR 00766-1716 |
Second Address | Ponce, PR 00716-2001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2006 |
Last Update Date | 08/07/2007 |