Provider Demographics
NPI:1851059695
Name:ROIG ROA, DAGMAR LEIAN (MD)
Entity Type:Individual
Prefix:
First Name:DAGMAR
Middle Name:LEIAN
Last Name:ROIG ROA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 CALLE ANGELES
Mailing Address - Street 2:URB EL PARAISO
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612
Mailing Address - Country:US
Mailing Address - Phone:787-356-5428
Mailing Address - Fax:
Practice Address - Street 1:129 CARRETERA KM1
Practice Address - Street 2:AVE SAN LUIS
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-650-7272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-29
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15820I208D00000X
PR23280390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice