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General NPI Number Information
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NPI Number | 1104511310
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Entity Type | Organization
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Legal Business Name | ROLARADOX WESTERN PEDIATRIC SERVICES, INC.
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Dates
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Enumeration Date | 04/05/2023
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Last Update Date | 04/05/2023
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Provider Practice Location Address
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Address Line | 60 CALLE DR RAMON E BETANCES N STE 208
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City | MAYAGUEZ
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State | PR
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Zip | 00680-6695
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Country | US
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Telephone | 787-833-5450
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Fax | 787-265-8844
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Provider Business Mailing Address
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Address Line | PO BOX 366
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City | MAYAGUEZ
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State | PR
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Zip | 00681-0366
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Country | US
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Telephone | 787-306-4149
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. OLGA RODRIGUEZ
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Credential | MD
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Telephone | 787-306-4149
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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