Healthcare Provider Details

I. General information

NPI: 1972632347
Provider Name (Legal Business Name): JOSE A. ROLDAN-CORREA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2007
Last Update Date: 04/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ST RD 798 KM 0.5 , RIO CANAS
CAGUAS PR
00725-0001
US

IV. Provider business mailing address

280 LA SERRANIA
CAGUAS PR
00725-1810
US

V. Phone/Fax

Practice location:
  • Phone: 787-747-1930
  • Fax: 787-747-5931
Mailing address:
  • Phone: 787-747-1930
  • Fax: 787-747-5931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number948
License Number StatePR

VIII. Authorized Official

Name: MR. JOSE A ROLDAN-CORREA
Title or Position: OWNER
Credential: M.T
Phone: 787-747-1930