Provider Demographics
NPI:1962549873
Name:ROSADO, JAIME ANTONIO (MD)
Entity type:Individual
Prefix:DR
First Name:JAIME
Middle Name:ANTONIO
Last Name:ROSADO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 CALLE 65 INFANTERIA
Mailing Address - Street 2:
Mailing Address - City:ANASCO
Mailing Address - State:PR
Mailing Address - Zip Code:00610-2941
Mailing Address - Country:US
Mailing Address - Phone:787-826-0880
Mailing Address - Fax:787-826-0880
Practice Address - Street 1:118 CALLE 65 INFANTERIA
Practice Address - Street 2:
Practice Address - City:ANASCO
Practice Address - State:PR
Practice Address - Zip Code:00610-2941
Practice Address - Country:US
Practice Address - Phone:787-826-0880
Practice Address - Fax:787-826-0880
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11977174400000X, 208M00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No174400000XOther Service ProvidersSpecialist
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG43084Medicare UPIN