Provider Demographics
NPI:1528651056
Name:ROSARIO, ROBERTO ENRIQUE (AGPCNP-C)
Entity type:Individual
Prefix:
First Name:ROBERTO
Middle Name:ENRIQUE
Last Name:ROSARIO
Suffix:
Gender:M
Credentials:AGPCNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 TWIN DEER LN
Mailing Address - Street 2:
Mailing Address - City:CANYON LAKE
Mailing Address - State:TX
Mailing Address - Zip Code:78133-3716
Mailing Address - Country:US
Mailing Address - Phone:210-918-0320
Mailing Address - Fax:
Practice Address - Street 1:1800 NE I410 STE 400
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217
Practice Address - Country:US
Practice Address - Phone:210-377-3444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-16
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAG01210082363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology