Individual provider Active NPI

Aida M Rios Roldan, DMD

  • Dentist
  • San Juan, PR
National Provider Identifier
1649324864
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
1438 Issued in PR
Practice address
2T1 Emiliano Pol Ave
Urb la Cumbre
San Juan, PR 00926
Phone
(787) 720-1625
NPI assigned
Jan 23, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 1438 PR Primary

Addresses

Primary practice location

2T1 Emiliano Pol Ave
Urb la Cumbre
San Juan, PR 00926

Mailing address

PO Box 270269
San Juan, PR 00927-0269
Phone (787) 720-1625

Other identifiers 4

IdentifierTypeStateIssuer
9260015OtherPRHUMANA
41300OtherPRTRIPLE S
41052OtherPRCRUZ AZUL
206551OtherUTI OF PR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170120001480 PR Order and Referring Only - Other (Physician)Practitioner - Other (Physician) 2961784228

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1438PRMDNutritionist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169510400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1649324864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 270269",
            "city": "SAN JUAN",
            "state": "PR",
            "postal_code": "009270269",
            "telephone_number": "787-720-1625"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2T1 EMILIANO POL AVE",
            "address_2": "URB LA CUMBRE",
            "city": "SAN JUAN",
            "state": "PR",
            "postal_code": "00926",
            "telephone_number": "787-720-1625"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RIOS ROLDAN",
        "first_name": "AIDA",
        "middle_name": "M",
        "name_prefix": "Mrs.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-23",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "PR",
            "license": "1438",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HUMANA",
            "identifier": "9260015",
            "state": "PR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRIPLE S",
            "identifier": "41300",
            "state": "PR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CRUZ AZUL",
            "identifier": "41052",
            "state": "PR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UTI OF PR",
            "identifier": "206551",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Juan, PR

Sources for this page

Verify at the official NPI Registry.