Provider Demographics
NPI:1437111234
Name:ROLON-MARINA, JOSE A
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:A
Last Name:ROLON-MARINA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1934
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00613-1934
Mailing Address - Country:US
Mailing Address - Phone:787-815-0443
Mailing Address - Fax:787-815-0403
Practice Address - Street 1:STREET 9 M-6
Practice Address - Street 2:VILLA LOS SANTOS
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-815-0443
Practice Address - Fax:787-815-0403
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12339208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR6130077OtherHUMANA
PR1744OtherAMERICAN HEALTH
PRB510OtherSERVIMED
PR1233OtherPREFERRED MED CHOICE
PR88656R0OtherTRIPLE S INC
PR34841OtherPRUSSAM
PR8897OtherINT MED CARD
PRB510OtherSERVIMED
PR88656Medicare ID - Type Unspecified