Provider Demographics
NPI:1487918645
Name:ROSADO-GUZMAN, LILIANA
Entity type:Individual
Prefix:MRS
First Name:LILIANA
Middle Name:
Last Name:ROSADO-GUZMAN
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 1:16 FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-4618
Mailing Address - Country:US
Mailing Address - Phone:917-957-4169
Mailing Address - Fax:
Practice Address - Street 1:16 FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-4618
Practice Address - Country:US
Practice Address - Phone:917-957-4169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-02
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY13724194OtherUMR