Provider Demographics
NPI:1013364207
Name:ROLAND GRACIA PA
Entity Type:Organization
Organization Name:ROLAND GRACIA PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROLAND
Authorized Official - Middle Name:
Authorized Official - Last Name:GRACIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-562-2150
Mailing Address - Street 1:1111 CRANDON BLVD
Mailing Address - Street 2:A-1004
Mailing Address - City:KEY BISCAYNE
Mailing Address - State:FL
Mailing Address - Zip Code:33149-2745
Mailing Address - Country:US
Mailing Address - Phone:305-562-2150
Mailing Address - Fax:
Practice Address - Street 1:1111 CRANDON BLVD APT A1004
Practice Address - Street 2:
Practice Address - City:KEY BISCAYNE
Practice Address - State:FL
Practice Address - Zip Code:33149-2618
Practice Address - Country:US
Practice Address - Phone:305-562-2150
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-18
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME340752085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty