Healthcare Provider Details

I. General information

NPI: 1518952092
Provider Name (Legal Business Name): ROQUE CESAR NIDO LANAUSSE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 03/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 CALLEJON LOS VETERANOS GUAYAMA MEDICAL CENTER, 1ST FLOOR
GUAYAMA PR
00784-5984
US

IV. Provider business mailing address

PO BOX 180
GUAYAMA PR
00785-0180
US

V. Phone/Fax

Practice location:
  • Phone: 787-864-1012
  • Fax: 787-866-2125
Mailing address:
  • Phone: 787-864-1012
  • Fax: 787-866-2125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number7453
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: