Active NPI
Christian J Miranda Roldan, SW
- Social Worker
- Canovanas, PR
National Provider Identifier
1124867478
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 15571
- Practice address
- PO Box 2394
Canovanas, PR 00729-2394 - Phone
- (787) 392-2577
- NPI assigned
- May 24, 2024
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pastoral Counselor | 101YP1600X | PR | ||
| Social Worker | 104100000X | 15571 | PR | Primary |
Addresses
Primary practice location
PO Box 2394
Canovanas, PR 00729-2394
Mailing address
PO Box 2394
Canovanas, PR 00729-2394
Phone (787) 392-2577
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15571 | PR | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1716508800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1716508800000",
"number": "1124867478",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2394",
"city": "CANOVANAS",
"state": "PR",
"postal_code": "007292394",
"telephone_number": "787-392-2577"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "PO BOX 2394",
"city": "CANOVANAS",
"state": "PR",
"postal_code": "007292394",
"telephone_number": "787-392-2577"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MIRANDA ROLDAN",
"first_name": "CHRISTIAN",
"middle_name": "J",
"credential": "SW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-05-24",
"last_updated": "2024-05-24",
"certification_date": "2024-05-24",
"status": "A"
},
"taxonomies": [
{
"code": "101YP1600X",
"taxonomy_group": "",
"desc": "Counselor, Pastoral",
"state": "PR",
"license": null,
"primary": false
},
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "PR",
"license": "15571",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Canovanas, PR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.