Provider Demographics
NPI:1083473714
Name:ROSALDO, ROMMEL
Entity Type:Individual
Prefix:
First Name:ROMMEL
Middle Name:
Last Name:ROSALDO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143RD ST
Mailing Address - Street 2:NA
Mailing Address - City:HOMER GLEN
Mailing Address - State:IL
Mailing Address - Zip Code:60491-5896
Mailing Address - Country:US
Mailing Address - Phone:708-446-8448
Mailing Address - Fax:708-590-5131
Practice Address - Street 1:143RD ST
Practice Address - Street 2:NA
Practice Address - City:HOMER GLEN
Practice Address - State:IL
Practice Address - Zip Code:60491-5896
Practice Address - Country:US
Practice Address - Phone:708-446-8448
Practice Address - Fax:708-590-5131
Is Sole Proprietor?:No
Enumeration Date:2024-03-15
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041436294163WI0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WI0600XNursing Service ProvidersRegistered NurseInfection Control