Provider Demographics
NPI:1487176681
Name:ROSARIO, GILBERTO J (LND, ISAK 1, EDPR)
Entity type:Individual
Prefix:MR
First Name:GILBERTO
Middle Name:J
Last Name:ROSARIO
Suffix:
Gender:M
Credentials:LND, ISAK 1, EDPR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1933 CALLE M MALDONADO
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-7749
Mailing Address - Country:US
Mailing Address - Phone:787-367-2037
Mailing Address - Fax:
Practice Address - Street 1:1777 CARR 844
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-4434
Practice Address - Country:US
Practice Address - Phone:787-748-9955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-10
Last Update Date:2017-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1700133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic