Provider Demographics
NPI:1699054544
Name:ROSADO, YELIANN MARIE (OTA)
Entity type:Individual
Prefix:
First Name:YELIANN
Middle Name:MARIE
Last Name:ROSADO
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BO CEIBA PAC HEIVA CARR 173 R 782 KM2 H1 INT
Mailing Address - Street 2:
Mailing Address - City:CIDRA
Mailing Address - State:PR
Mailing Address - Zip Code:00739-7912
Mailing Address - Country:US
Mailing Address - Phone:787-365-9893
Mailing Address - Fax:
Practice Address - Street 1:759 AVE AVELINO VICENTE
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-2538
Practice Address - Country:US
Practice Address - Phone:787-644-9628
Practice Address - Fax:787-724-5559
Is Sole Proprietor?:No
Enumeration Date:2011-08-10
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1396871570174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist