Provider Demographics
NPI:1154814259
Name:ROSARIO, JAIME DAVID SR (CPL)
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:DAVID
Last Name:ROSARIO
Suffix:SR
Gender:M
Credentials:CPL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:E37 CALLE RAMON QUINONES
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00983-1816
Mailing Address - Country:US
Mailing Address - Phone:787-632-8160
Mailing Address - Fax:
Practice Address - Street 1:90 ANTONIO JIMENEZ LANDRAU
Practice Address - Street 2:SAN RAFAEL
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985
Practice Address - Country:US
Practice Address - Phone:787-944-4411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-13
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4092101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1772573OtherDRIVER LICENSE