Healthcare Provider Details

I. General information

NPI: 1467212324
Provider Name (Legal Business Name): CHRISTINA RAQUEL ROLDAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2024
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 LAS VEGAS BLVD NORTH NELLIS AFB
LAS VEGAS NV
89191-6601
US

IV. Provider business mailing address

245 E CENTENNIAL PKWY APT 1063
NORTH LAS VEGAS NV
89084-1358
US

V. Phone/Fax

Practice location:
  • Phone: 702-653-2273
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License NumberLL4374
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: