=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255460317
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BORIS ROJAS M.D, FAADEP
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/05/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | SAN JUAN HEALTH CTR DE DIEGO AND BALDORIOTY AVE. #150, SUITE 703
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00907-2300
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-724-5155
-----------------------------------------------------
Fax | 787-724-5167
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | SAN JUAN HEALTH CTR DE DIEGO AND BALDORIOTY AVE. #150, SUITE 703
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00907-2300
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-724-5155
-----------------------------------------------------
Fax | 787-724-5167
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 4300
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------