Basic Information
| Provider Information | |||||||||
| NPI: | 1467987263 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ENCARNACION | ||||||||
| FirstName: | ROLANDO | ||||||||
| MiddleName: | JOEL | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | BO MONACILLOS CARR#22 | ||||||||
| Address2: | RIO PIEDRAS | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00921 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7874740333 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | BO MONACILLOS CARR#22 | ||||||||
| Address2: | RIO PIEDRAS | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00921 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7874740333 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/29/2017 | ||||||||
| LastUpdateDate: | 01/24/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/19/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 35454 | PR | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.