Provider Demographics
NPI:1902338197
Name:ROSARIO, CAROLL
Entity Type:Individual
Prefix:
First Name:CAROLL
Middle Name:
Last Name:ROSARIO
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:STREET 20 URB PRADERA
Mailing Address - Street 2:SUITE AU25
Mailing Address - City:TOA BAJA
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00949
Mailing Address - Country:UM
Mailing Address - Phone:787-299-5231
Mailing Address - Fax:
Practice Address - Street 1:STREET 20 URB PRADERA
Practice Address - Street 2:SUITE AU25
Practice Address - City:TOA BAJA
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00949
Practice Address - Country:UM
Practice Address - Phone:787-299-5231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-28
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4040235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist