Provider Demographics
NPI:1386421543
Name:ROLDAN HERNANDEZ, XAHIRA (MS)
Entity type:Individual
Prefix:
First Name:XAHIRA
Middle Name:
Last Name:ROLDAN HERNANDEZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 5 BOX 15551
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676-9649
Mailing Address - Country:US
Mailing Address - Phone:939-249-9230
Mailing Address - Fax:
Practice Address - Street 1:300 AVE NOEL ESTRADA
Practice Address - Street 2:
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662-3275
Practice Address - Country:US
Practice Address - Phone:787-669-3815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-12
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8033103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling