Provider Demographics
NPI:1265041966
Name:COMIA, ROLLY ABUTAL (BSN RN)
Entity Type:Individual
Prefix:
First Name:ROLLY
Middle Name:ABUTAL
Last Name:COMIA
Suffix:
Gender:M
Credentials:BSN RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6963 E MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-1443
Mailing Address - Country:US
Mailing Address - Phone:559-375-1658
Mailing Address - Fax:
Practice Address - Street 1:6963 E MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727-1443
Practice Address - Country:US
Practice Address - Phone:559-375-1658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-28
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA694553163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergencyGroup - Multi-Specialty