Provider Demographics
NPI:1316288558
Name:ROSARIO, GIOVANNA MARIE (LND, RD)
Entity type:Individual
Prefix:
First Name:GIOVANNA
Middle Name:MARIE
Last Name:ROSARIO
Suffix:
Gender:F
Credentials:LND, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:STREET 12 HOUSE T7
Mailing Address - Street 2:EXTENSION VILLA RICA
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959-5143
Mailing Address - Country:US
Mailing Address - Phone:939-350-0281
Mailing Address - Fax:
Practice Address - Street 1:EXTENSION VILLA RICA STREET 12 T-7
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-5143
Practice Address - Country:US
Practice Address - Phone:939-350-0281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-13
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1701133V00000X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered