Provider Demographics
NPI:1790818169
Name:ROQUES, ELISEO (MD)
Entity Type:Individual
Prefix:DR
First Name:ELISEO
Middle Name:
Last Name:ROQUES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 WINSTON CHURCHILL AVE.
Mailing Address - Street 2:MSC 853
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-6023
Mailing Address - Country:US
Mailing Address - Phone:787-764-3562
Mailing Address - Fax:787-753-0996
Practice Address - Street 1:PARANA CORNER CARITE 125
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-6023
Practice Address - Country:US
Practice Address - Phone:787-764-3562
Practice Address - Fax:787-753-0996
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4783208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR3882OtherBLUE CROSS
PR906044OtherTRIPLES