Provider Demographics
NPI:1376659243
Name:YARRITU, ROLANDO (MD)
Entity Type:Individual
Prefix:
First Name:ROLANDO
Middle Name:
Last Name:YARRITU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3046
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-0746
Mailing Address - Country:US
Mailing Address - Phone:956-292-0781
Mailing Address - Fax:956-382-4022
Practice Address - Street 1:1200 S 10TH AVE
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-5516
Practice Address - Country:US
Practice Address - Phone:956-292-0781
Practice Address - Fax:956-382-4022
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF7336207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1161051-04Medicaid
TX346053YKSJMedicare PIN
TX1161051-04Medicaid
TX010034176OtherRAILROAD MEDICARE
TX124802OtherSUPERIOR HEALTHPLAN NETWORK
TXB27717Medicare UPIN
TX806035Medicare ID - Type Unspecified