Provider Demographics
NPI:1689701047
Name:PABON, ROLDAN CRESPO
Entity Type:Individual
Prefix:
First Name:ROLDAN
Middle Name:CRESPO
Last Name:PABON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ROLDAN
Other - Middle Name:JOSE
Other - Last Name:CRESPO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:5707 N 22ND STREET
Mailing Address - Street 2:MENTAL HEALTH CARE INC
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33610
Mailing Address - Country:US
Mailing Address - Phone:813-272-2878
Mailing Address - Fax:813-272-3766
Practice Address - Street 1:5707 N 22ND STREET
Practice Address - Street 2:MENTAL HEALTH CARE INC
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33610
Practice Address - Country:US
Practice Address - Phone:813-272-2878
Practice Address - Fax:813-272-3766
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical