1972632347 NPI number — JOSE A. ROLDAN-CORREA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972632347 NPI number — JOSE A. ROLDAN-CORREA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOSE A. ROLDAN-CORREA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1972632347
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/07/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
280 LA SERRANIA
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAGUAS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00725-1810
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-747-1930
Provider Business Mailing Address Fax Number:
787-747-5931

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ST RD 798 KM 0.5 , RIO CANAS
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAGUAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00725-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-747-1930
Provider Business Practice Location Address Fax Number:
787-747-5931
Provider Enumeration Date:
03/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ROLDAN-CORREA
Authorized Official First Name:
JOSE
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
787-747-1930

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  948 , 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)

  • Identifier: 0031322 . This is a "MEDICARE PART B PROVIDER" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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