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General NPI Number Information
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NPI Number | 1437844560
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Entity Type | Individual
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Provider Name | FAUSTINA VIRTUDES ROLDAN CBHCM103913
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Gender | Female
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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 | 12150 SW 128TH CT STE 228
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City | MIAMI
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State | FL
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Zip | 33186-4674
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Country | US
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Telephone | 786-227-6314
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Fax |
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Provider Business Mailing Address
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Address Line | 14820 GRANT LN
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City | HOMESTEAD
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State | FL
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Zip | 33033-2726
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Country | US
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Telephone | 786-370-4457
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 103913
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License Number State | FL
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