Healthcare Provider Details

I. General information

NPI: 1689502932
Provider Name (Legal Business Name): KEISHLA ANNETTE VALENTIN ROLDAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3170 AVE MILITAR
ISABELA PR
00662-4062
US

IV. Provider business mailing address

PO BOX 484
ISABELA PR
00662-0484
US

V. Phone/Fax

Practice location:
  • Phone: 787-830-8866
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number003105-P.A.
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: