Provider Demographics
NPI:1104511310
Name:ROLARADOX WESTERN PEDIATRIC SERVICES, INC.
Entity type:Organization
Organization Name:ROLARADOX WESTERN PEDIATRIC SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:OLGA
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-306-4149
Mailing Address - Street 1:PO BOX 366
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-0366
Mailing Address - Country:US
Mailing Address - Phone:787-306-4149
Mailing Address - Fax:
Practice Address - Street 1:60 CALLE DR RAMON E BETANCES N STE 208
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-6695
Practice Address - Country:US
Practice Address - Phone:787-833-5450
Practice Address - Fax:787-265-8844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-05
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty