Provider Demographics
NPI:1902137698
Name:GARDESLEN, ROEL ELFRIETH (MEDICINE)
Entity Type:Individual
Prefix:DR
First Name:ROEL
Middle Name:ELFRIETH
Last Name:GARDESLEN
Suffix:
Gender:M
Credentials:MEDICINE
Other - Prefix:DR
Other - First Name:ROEL
Other - Middle Name:ELFRIETH
Other - Last Name:GARDESLEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MEDICINE
Mailing Address - Street 1:#5 URB.LAS FLORES J7
Mailing Address - Street 2:
Mailing Address - City:JUANA DIAZ
Mailing Address - State:PR
Mailing Address - Zip Code:00795
Mailing Address - Country:US
Mailing Address - Phone:787-901-0815
Mailing Address - Fax:
Practice Address - Street 1:#5 URB.LAS FLORES J7
Practice Address - Street 2:
Practice Address - City:JUANA DIAZ
Practice Address - State:PR
Practice Address - Zip Code:00795
Practice Address - Country:US
Practice Address - Phone:787-901-0815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-20
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17716208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice