Provider Demographics
NPI:1316966161
Name:DELIZ ROLDAN, ELGA MAYTEE (AUD54)
Entity type:Individual
Prefix:MRS
First Name:ELGA
Middle Name:MAYTEE
Last Name:DELIZ ROLDAN
Suffix:
Gender:F
Credentials:AUD54
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31-1 CALLE 31
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00983-2962
Mailing Address - Country:US
Mailing Address - Phone:939-639-2845
Mailing Address - Fax:787-762-3737
Practice Address - Street 1:2716 ROBERTO CLEMENTE AVE.
Practice Address - Street 2:URB. VILLA CAROLINA
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985
Practice Address - Country:US
Practice Address - Phone:787-762-3737
Practice Address - Fax:787-762-3737
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR583231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRQ-69202Medicare UPIN