Provider Demographics
NPI:1740364587
Name:ALICEA-ROLON, JUAN A (MD)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:A
Last Name:ALICEA-ROLON
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:ARROYO BEACH RESORT
Mailing Address - Street 2:APT 15
Mailing Address - City:ARROYO
Mailing Address - State:PR
Mailing Address - Zip Code:00714-0000
Mailing Address - Country:US
Mailing Address - Phone:787-930-2520
Mailing Address - Fax:787-848-0318
Practice Address - Street 1:CALLE DR ISAAC GONZALEZ ESQUINA LEDESMA
Practice Address - Street 2:ANEXO HOSPITAL METROPOLITANO
Practice Address - City:UTUADO
Practice Address - State:PR
Practice Address - Zip Code:00641-2635
Practice Address - Country:US
Practice Address - Phone:787-933-2000
Practice Address - Fax:787-930-2520
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR07928207RI0011X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG1788AOtherPTAN
F20048Medicare UPIN
4096152Medicare ID - Type Unspecified
WV001719257OtherBCBS