Provider Demographics
NPI:1104554005
Name:DE JESUS ROSARIO, ORLANDO EMANUEL (PSYD)
Entity type:Individual
Prefix:DR
First Name:ORLANDO
Middle Name:EMANUEL
Last Name:DE JESUS ROSARIO
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB BAYAMON GARDENS CALLE EVERARDA GG18
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00957-2553
Mailing Address - Country:US
Mailing Address - Phone:787-423-7018
Mailing Address - Fax:
Practice Address - Street 1:URB. CANA, PP-14 CALLE 5
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00957
Practice Address - Country:US
Practice Address - Phone:787-944-4433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-10
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7339103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty