Active NPI
Eliseo Roques, M.D.
- Pediatrics Physician
- San Juan, PR
National Provider Identifier
1790818169
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 4783
- Practice address
- Parana Corner Carite 125
San Juan, PR 00926-6023 - Phone
- (787) 764-3562
- Fax
- (787) 753-0996
- NPI assigned
- Mar 14, 2007
- Last updated
- Jul 8, 2007
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 4783 | PR | Primary |
Addresses
Primary practice location
Parana Corner Carite 125
San Juan, PR 00926-6023
Mailing address
138 Winston Churchill Ave.
MSC 853
San Juan, PR 00926-6023
Phone (787) 764-3562
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 906044 | Other | PR | TRIPLES |
| 3882 | Other | PR | BLUE CROSS |
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
| License | State | Type | Specialty |
|---|---|---|---|
| 4783 | PR | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173830400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1790818169",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "138 WINSTON CHURCHILL AVE.",
"address_2": "MSC 853",
"city": "SAN JUAN",
"state": "PR",
"postal_code": "009266023",
"telephone_number": "787-764-3562",
"fax_number": "787-753-0996"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "PARANA CORNER CARITE 125",
"city": "SAN JUAN",
"state": "PR",
"postal_code": "009266023",
"telephone_number": "787-764-3562",
"fax_number": "787-753-0996"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROQUES",
"first_name": "ELISEO",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-14",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "PR",
"license": "4783",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRIPLES",
"identifier": "906044",
"state": "PR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "3882",
"state": "PR"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Juan, PR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.