=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285994756
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAURA CRISTINA ROLDAN VELEZ M.D
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/18/2012
-----------------------------------------------------
Last Update Date | 08/25/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 371 AVE DE DIEGO
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00909-1711
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-649-5371
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 52 CALLE SAN JOSE ESTANCIAS DE GRAN VISTA
-----------------------------------------------------
City | GURABO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00778
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-649-5371
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 018851
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------