Individual provider Active NPI

Nanichi Alexandra Ramos Roldan

  • Pediatric Rehabilitation Medicine Physician
  • Philadelphia, PA
National Provider Identifier
1710483029
Registry record updated Sep 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Rehabilitation Medicine PhysicianTaxonomy code 2081P0010X
License
MD485459 Issued in PA
Practice address
3500 Civic Center Blvd
Philadelphia, PA 19104-4395
Phone
(215) 590-1000
NPI assigned
Apr 4, 2018
Last updated
Sep 25, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 25, 2024

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Student in an Organized Health Care Education/Training Program 390200000X TRN31182 FL
Physical Medicine & Rehabilitation Physician 208100000X 14837 PR
Pediatric Rehabilitation Medicine Physician 2081P0010X MD485459 PA Primary

Addresses

Primary practice location

3500 Civic Center Blvd
Philadelphia, PA 19104-4395

Mailing address

24C Calle Barranquitas
Caguas, PR 00727-4950

Other practice location 1

Area de Centro Medico
PM&R Department
San Juan, PR 00921
Phone (787) 751-9625

Other practice location 2

Area de Centro Medico
1156-1178 Cll 62 SE
San Juan, PR 00921
Phone (787) 751-9625

Other practice location 3

1611 NW 12th Ave
Miami, FL 33136-1005
Phone (305) 585-9600

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
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD485459PAMDPediatric Rehabilitation Medicine Physician
TRN31182FLMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Childrens Health Care Associates of New Jersey PC Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1522800000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727222400000",
    "number": "1710483029",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24C CALLE BARRANQUITAS",
            "city": "CAGUAS",
            "state": "PR",
            "postal_code": "007274950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3500 CIVIC CENTER BLVD",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191044395",
            "telephone_number": "215-590-1000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "Area de Centro Medico",
            "address_2": "PM&R Department",
            "address_purpose": "LOCATION",
            "city": "San Juan",
            "state": "PR",
            "postal_code": "00921",
            "country_code": "US",
            "telephone_number": "787-751-9625",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "Area de Centro Medico",
            "address_2": "1156-1178 Cll 62 SE",
            "address_purpose": "LOCATION",
            "city": "San Juan",
            "state": "PR",
            "postal_code": "00921",
            "country_code": "US",
            "telephone_number": "787-751-9625",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1611 NW 12th Ave",
            "address_purpose": "LOCATION",
            "city": "Miami",
            "state": "FL",
            "postal_code": "331361005",
            "country_code": "US",
            "telephone_number": "305-585-9600",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RAMOS ROLDAN",
        "first_name": "NANICHI",
        "middle_name": "ALEXANDRA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-04-04",
        "last_updated": "2024-09-25",
        "certification_date": "2024-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "FL",
            "license": "TRN31182",
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "PR",
            "license": "14837",
            "primary": false
        },
        {
            "code": "2081P0010X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Pediatric Rehabilitation Medicine",
            "state": "PA",
            "license": "MD485459",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 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.

Verify at the official NPI Registry.