NPIMap

Individual provider Active NPI

Roel Elfrieth Gardeslen, MEDICINE

  • General Practice Physician
  • Juana Diaz, PR
National Provider Identifier
1902137698
Registry record updated Jan 20, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
17716 Issued in PR
Practice address
#5 Urb.Las Flores J7
Juana Diaz, PR 00795
Phone
(787) 901-0815
NPI assigned
Jan 20, 2010
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 20, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X 17716 PR Primary

Addresses

Primary practice location

#5 Urb.Las Flores J7
Juana Diaz, PR 00795

Mailing address

#5 Urb.Las Flores J7
Juana Diaz, PR 00795
Phone (787) 901-0815

Other names 1

  • Dr. Roel Elfrieth Gardeslen Professional name

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

LicenseStateTypeSpecialty
17716PRMDGeneral Practice Physician

NPI Registry JSON

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

{
    "created_epoch": "1263945600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1263945600000",
    "number": "1902137698",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "#5 URB.LAS FLORES J7",
            "city": "JUANA DIAZ",
            "state": "PR",
            "postal_code": "00795",
            "telephone_number": "787-901-0815"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "#5 URB.LAS FLORES J7",
            "city": "JUANA DIAZ",
            "state": "PR",
            "postal_code": "00795",
            "telephone_number": "787-901-0815"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GARDESLEN",
        "first_name": "ROEL",
        "middle_name": "ELFRIETH",
        "name_prefix": "Dr.",
        "credential": "MEDICINE",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-01-20",
        "last_updated": "2010-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "PR",
            "license": "17716",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ROEL",
            "last_name": "GARDESLEN",
            "middle_name": "ELFRIETH",
            "prefix": "DR.",
            "credential": "MEDICINE",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Juana Diaz, PR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2010; 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.