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General NPI Number Information
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NPI Number | 1699271536
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Entity Type | Individual
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Provider Name | LUIS PABLO ROLDAN
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Gender | Male
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Dates
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Enumeration Date | 03/31/2018
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Last Update Date | 08/01/2024
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Provider Practice Location Address
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Address Line | 3800 JOHNSON ST STE A
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City | HOLLYWOOD
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State | FL
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Zip | 33021-6052
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Country | US
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Telephone | 305-558-3724
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Fax |
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Provider Business Mailing Address
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Address Line | 15280 NW 79TH CT
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City | MIAMI LAKES
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State | FL
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Zip | 33016-5789
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Country | US
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Telephone | 305-558-3724
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | ME163609
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License Number State | FL
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