Provider Demographics
NPI:1093776528
Name:ROLON-MIRANDA, JOSE ALBERTO (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:ALBERTO
Last Name:ROLON-MIRANDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 10609
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-0609
Mailing Address - Country:US
Mailing Address - Phone:787-848-3388
Mailing Address - Fax:787-840-5852
Practice Address - Street 1:44 CALLE FLORENCIO SANTIAGO
Practice Address - Street 2:
Practice Address - City:COAMO
Practice Address - State:PR
Practice Address - Zip Code:00769-3208
Practice Address - Country:US
Practice Address - Phone:787-825-2580
Practice Address - Fax:787-825-8319
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-01
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6801207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR6801OtherMD LICENCE
PR-C78229Medicare UPIN
PR6801OtherMD LICENCE