Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 0488 | PR |
NPI | 1588869234 |
---|---|
Provider Name | Wilfredo Rosado |
First Address | Guaynabo, PR 00969-3516 |
Second Address | Guaynabo, PR 00969-3516 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2007 |
Last Update Date | 08/07/2007 |