Provider Demographics
NPI:1295467199
Name:ALDARONDO ROSADO, BENYVETTE
Entity type:Individual
Prefix:
First Name:BENYVETTE
Middle Name:
Last Name:ALDARONDO ROSADO
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:STATE ROAD 129 KM 25.4
Mailing Address - Street 2:
Mailing Address - City:LARES
Mailing Address - State:PR
Mailing Address - Zip Code:00669-0761
Mailing Address - Country:US
Mailing Address - Phone:787-567-6028
Mailing Address - Fax:
Practice Address - Street 1:4850 AVE MILITAR
Practice Address - Street 2:
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662-6108
Practice Address - Country:US
Practice Address - Phone:787-567-6028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR22839208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice