Provider Demographics
NPI:1487732988
Name:ROLDAN, GUADALUPE (MD)
Entity type:Individual
Prefix:
First Name:GUADALUPE
Middle Name:
Last Name:ROLDAN
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 1:14023 SOUTHWEST FWY
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-3550
Mailing Address - Country:US
Mailing Address - Phone:281-325-4210
Mailing Address - Fax:
Practice Address - Street 1:1800 W 26TH ST STE 103
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-1451
Practice Address - Country:US
Practice Address - Phone:713-957-8400
Practice Address - Fax:713-957-2133
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP6069207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX323912101Medicaid