Provider Demographics
NPI:1194072744
Name:ELIA, MILAGROS ROSADO
Entity type:Individual
Prefix:MRS
First Name:MILAGROS
Middle Name:ROSADO
Last Name:ELIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1465 E PUTNAM AVE
Mailing Address - Street 2:#122
Mailing Address - City:OLD GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06870-1338
Mailing Address - Country:US
Mailing Address - Phone:203-637-3080
Mailing Address - Fax:
Practice Address - Street 1:1465 E PUTNAM AVE
Practice Address - Street 2:#122
Practice Address - City:OLD GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06870-1338
Practice Address - Country:US
Practice Address - Phone:203-637-3080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-13
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004969363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health