1174847321 NPI number — MISS SANDRA ROLDAN LMT

Table of content: MISS SANDRA ROLDAN LMT (NPI 1174847321)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174847321 NPI number — MISS SANDRA ROLDAN LMT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROLDAN
Provider First Name:
SANDRA
Provider Middle Name:
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
LMT
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:
1174847321
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/14/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
304 W HALLANDALE BEACH BLVD
Provider Second Line Business Mailing Address:
HALLANDALE BEACH , FL 33009
Provider Business Mailing Address City Name:
HALLANDALE BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33009-5444
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-454-4280
Provider Business Mailing Address Fax Number:
954-922-3841

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1801 S OCEAN DR
Provider Second Line Business Practice Location Address:
SUITE E
Provider Business Practice Location Address City Name:
HALLANDALE BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33009-4945
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-391-7864
Provider Business Practice Location Address Fax Number:
954-391-8468
Provider Enumeration Date:
03/17/2010

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: 225700000X , with the licence number:  MA44797 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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