Provider Demographics
NPI:1528815263
Name:ROA MEDICAL LLC
Entity type:Organization
Organization Name:ROA MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:I
Authorized Official - Last Name:ORTIZ ALMANZAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-234-2177
Mailing Address - Street 1:REPARTO ANAMAR
Mailing Address - Street 2:14 CALLE DIGITALIS
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:371 CALLE DE DIEGO
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00923-3002
Practice Address - Country:US
Practice Address - Phone:787-767-5100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-01
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty