Provider Demographics
NPI:1285931824
Name:ROSTELL PROFESSIONAL SERVICES, PSC
Entity type:Organization
Organization Name:ROSTELL PROFESSIONAL SERVICES, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANCISCO
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROSADO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-675-4038
Mailing Address - Street 1:PO BOX 230
Mailing Address - Street 2:
Mailing Address - City:PENUELAS
Mailing Address - State:PR
Mailing Address - Zip Code:00624-0230
Mailing Address - Country:US
Mailing Address - Phone:787-675-4038
Mailing Address - Fax:787-842-0715
Practice Address - Street 1:1 STREET BUCANA
Practice Address - Street 2:BO CAOBOS
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-0000
Practice Address - Country:US
Practice Address - Phone:787-842-0715
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-17
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17553208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PREK095AMedicare UPIN
PR15911Medicare UPIN