Provider Demographics
NPI:1609277797
Name:DRA DIGNA RIVERA ROLDAN MEDICINA GENERAL CSP
Entity Type:Organization
Organization Name:DRA DIGNA RIVERA ROLDAN MEDICINA GENERAL CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DIGNA
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA ROLDAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-841-3114
Mailing Address - Street 1:1120 CALLE CARLOS E CHARDON
Mailing Address - Street 2:VILLAS DE RIO CANAS
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00728-1931
Mailing Address - Country:US
Mailing Address - Phone:787-841-3114
Mailing Address - Fax:787-841-3114
Practice Address - Street 1:53 AVE PADRE NOEL
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-8020
Practice Address - Country:US
Practice Address - Phone:787-841-3114
Practice Address - Fax:787-841-3114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-09
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty