Healthcare Provider Details

I. General information

NPI: 1528815263
Provider Name (Legal Business Name): ROA MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2024
Last Update Date: 08/30/2024
Certification Date: 08/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

371 CALLE DE DIEGO
SAN JUAN PR
00923-3002
US

IV. Provider business mailing address

REPARTO ANAMAR 14 CALLE DIGITALIS
TOA BAJA PR
00949
US

V. Phone/Fax

Practice location:
  • Phone: 787-767-5100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: RONALD I ORTIZ ALMANZAR
Title or Position: PRESIDENT
Credential: MD
Phone: 787-234-2177