Basic Information
| Provider Information | |||||||||
| NPI: | 1770898124 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DEYNES-ROLDAN | ||||||||
| FirstName: | LOIDA | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 787 CORTARO DR | ||||||||
| Address2: | |||||||||
| City: | RUSKIN | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335736812 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7872359329 | ||||||||
| FaxNumber: | 8136343008 | ||||||||
| Practice Location | |||||||||
| Address1: | 787 CORTARO DR | ||||||||
| Address2: | |||||||||
| City: | RUSKIN | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335736812 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8136342500 | ||||||||
| FaxNumber: | 8136343008 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2010 | ||||||||
| LastUpdateDate: | 08/13/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 20567 | PR | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | ME126149 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | FD3854418 | 01 | FL | DEA | OTHER | ME126149 | 01 | FL | MEDICAL LICENSE | OTHER | 016137800 | 05 | FL | MEDICAID | IJ658Y | 01 | FL | MEDICARE | OTHER |