1508002395 NPI number — DR. YESENIA E JUSTINIANO ROSARIO M.D.

Table of content: DR. YESENIA E JUSTINIANO ROSARIO M.D. (NPI 1508002395)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508002395 NPI number — DR. YESENIA E JUSTINIANO ROSARIO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JUSTINIANO ROSARIO
Provider First Name:
YESENIA
Provider Middle Name:
E
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508002395
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/14/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
48 ZEBULAHS TRL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PALM COAST
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32164-5260
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-317-7792
Provider Business Mailing Address Fax Number:
787-831-3270

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6 SAINT JOHNS MEDICAL PARK DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST AUGUSTINE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32086-5298
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-823-3301
Provider Business Practice Location Address Fax Number:
904-823-3328
Provider Enumeration Date:
12/28/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  17382 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)