Healthcare Provider Details

I. General information

NPI: 1043986375
Provider Name (Legal Business Name): EDDIE A SOLTREN ROLDAN MA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2021
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 189 BARRIO RINCON KM 3.1
GURABO PR
00778-3000
US

IV. Provider business mailing address

HC 60 BOX 41406
SAN LORENZO PR
00754-9015
US

V. Phone/Fax

Practice location:
  • Phone: 787-463-6203
  • Fax:
Mailing address:
  • Phone: 787-463-6203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number7081
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: