Provider Demographics
NPI:1902250483
Name:SANCHEZ ROSADO, MARIELA ODALISSE (MD)
Entity Type:Individual
Prefix:
First Name:MARIELA
Middle Name:ODALISSE
Last Name:SANCHEZ ROSADO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 CARR 2 APT 43
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-7372
Mailing Address - Country:US
Mailing Address - Phone:305-669-5873
Mailing Address - Fax:
Practice Address - Street 1:1005 JOE DIMAGGIO DR APT 1704
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-5487
Practice Address - Country:US
Practice Address - Phone:787-429-1730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME1396962080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program