Provider Demographics
NPI:1689452252
Name:AGUILAR ROLLERO, ELIAM LAZARO (BSN RN SRNA)
Entity Type:Individual
Prefix:
First Name:ELIAM
Middle Name:LAZARO
Last Name:AGUILAR ROLLERO
Suffix:
Gender:M
Credentials:BSN RN SRNA
Other - Prefix:
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Mailing Address - Street 1:420 CALLE SAN ANTONIO APT 301
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00915-0003
Mailing Address - Country:US
Mailing Address - Phone:832-257-3705
Mailing Address - Fax:
Practice Address - Street 1:DR. JOSE CELSO BARBOSA DRIVE
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921
Practice Address - Country:US
Practice Address - Phone:787-758-2525
Practice Address - Fax:708-782-4290
Is Sole Proprietor?:No
Enumeration Date:2023-09-15
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program