MEDICARE: NANICHI ALEXANDRA RAMOS 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	208100000X	Physical Medicine & Rehabilitation Physician	14837	PR
2	390200000X	Student in an Organized Health Care Education/Training Program
3	390200000X	Student in an Organized Health Care Education/Training Program	TRN31182	FL
4	2081P0010X	Pediatric Rehabilitation Medicine Physician	MD485459	PA

General Provider Information

NPI Number	:	1710483029
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANICHI ALEXANDRA RAMOS ROLDAN

Provider Business Mailing Address
First Line	:	24C CALLE BARRANQUITAS
Second Line	:
City	:	CAGUAS
State	:	PR
Zip	:	00727-4950
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3500 CIVIC CENTER BLVD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-4395
Country	:	US
Telephone Number	:	215-590-1000
Fax Number	:

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

Provider Enumeration Date	:	04/04/2018
Last Update Date	:	09/25/2024

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Directions to “ NANICHI ALEXANDRA RAMOS ROLDAN ” Practice Location

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