Provider Demographics
NPI:1548703465
Name:RESTO-ROLDAN, ESTEBAN
Entity type:Individual
Prefix:DR
First Name:ESTEBAN
Middle Name:
Last Name:RESTO-ROLDAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 631
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-0631
Mailing Address - Country:US
Mailing Address - Phone:787-429-3584
Mailing Address - Fax:
Practice Address - Street 1:302 CARR ERNESTO CARRASQUILLO
Practice Address - Street 2:
Practice Address - City:YABUCOA
Practice Address - State:PR
Practice Address - Zip Code:00767-3948
Practice Address - Country:US
Practice Address - Phone:787-893-4410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-25
Last Update Date:2016-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6443183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist