Provider Demographics
NPI:1700350782
Name:ROSADO, JANCY (LICENSED OPTICIAN)
Entity type:Individual
Prefix:
First Name:JANCY
Middle Name:
Last Name:ROSADO
Suffix:
Gender:F
Credentials:LICENSED OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB RESIDENCIAL BAIROA
Mailing Address - Street 2:BD1 CALLE 25A APT 4
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725
Mailing Address - Country:US
Mailing Address - Phone:787-966-9631
Mailing Address - Fax:
Practice Address - Street 1:URB RESIDENCIAL BAIROA
Practice Address - Street 2:BD1 CALLE 25A APT 4
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-966-9631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-14
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1218156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty