Provider Demographics
NPI:1053763821
Name:ROSADO DE JESUS, JUAN L (19435)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:L
Last Name:ROSADO DE JESUS
Suffix:
Gender:M
Credentials:19435
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 4 BOX 9216
Mailing Address - Street 2:
Mailing Address - City:UTUADO
Mailing Address - State:PR
Mailing Address - Zip Code:00641-7718
Mailing Address - Country:US
Mailing Address - Phone:787-422-6862
Mailing Address - Fax:
Practice Address - Street 1:HC 4 BOX 9216
Practice Address - Street 2:
Practice Address - City:UTUADO
Practice Address - State:PR
Practice Address - Zip Code:00641-7718
Practice Address - Country:US
Practice Address - Phone:787-422-6862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-05
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19435208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice