MEDICARE: KEISHLA ANNETTE VALENTIN ROLDAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	003105-P.A.	PR

General Provider Information

NPI Number	:	1689502932
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEISHLA ANNETTE VALENTIN ROLDAN

Provider Business Mailing Address
First Line	:	PO BOX 484
Second Line	:
City	:	ISABELA
State	:	PR
Zip	:	00662-0484
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3170 AVE MILITAR
Second Line	:
City	:	ISABELA
State	:	PR
Zip	:	00662-4062
Country	:	US
Telephone Number	:	787-830-8866
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2026
Last Update Date	:	05/08/2026

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