Provider Demographics
NPI:1467627448
Name:HALL, ROLANDO C (DOM LAP)
Entity Type:Individual
Prefix:DR
First Name:ROLANDO
Middle Name:C
Last Name:HALL
Suffix:
Gender:M
Credentials:DOM LAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2505 MILAGRO RIDGE CT NE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-2574
Mailing Address - Country:US
Mailing Address - Phone:505-702-9911
Mailing Address - Fax:
Practice Address - Street 1:7920 WYOMING BLVD NE
Practice Address - Street 2:SUITE B
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-6020
Practice Address - Country:US
Practice Address - Phone:505-821-6300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM961171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist