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General NPI Number Information
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NPI Number | 1518952092
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Entity Type | Individual
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Provider Name | ROQUE CESAR NIDO LANAUSSE M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/12/2005
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Last Update Date | 03/10/2011
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Provider Practice Location Address
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Address Line | 3 CALLEJON LOS VETERANOS GUAYAMA MEDICAL CENTER, 1ST FLOOR
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City | GUAYAMA
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State | PR
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Zip | 00784-5984
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Country | US
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Telephone | 787-864-1012
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Fax | 787-866-2125
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Provider Business Mailing Address
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Address Line | PO BOX 180
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City | GUAYAMA
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State | PR
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Zip | 00785-0180
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Country | US
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Telephone | 787-864-1012
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Fax | 787-866-2125
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 7453
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License Number State | PR
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