Provider Demographics
NPI:1053386813
Name:ROSSO, DIEGO E (MD)
Entity type:Individual
Prefix:DR
First Name:DIEGO
Middle Name:E
Last Name:ROSSO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1946
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-1946
Mailing Address - Country:US
Mailing Address - Phone:787-269-0811
Mailing Address - Fax:
Practice Address - Street 1:E29 CALLE HERNANDEZ CARRION
Practice Address - Street 2:
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674-4622
Practice Address - Country:US
Practice Address - Phone:787-854-0740
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10744207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR100007OtherMADVANTAGE, MMM HEALTHCAR
PR064670OtherCRUZ AZUL DE P.R.
PR83007Medicare ID - Type UnspecifiedMEDICARE PART B CARRIER
PR100007OtherMADVANTAGE, MMM HEALTHCAR