Provider Demographics
NPI:1508339375
Name:NANCY E ROLNIK MD PC
Entity Type:Organization
Organization Name:NANCY E ROLNIK MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROLNIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:925-464-7278
Mailing Address - Street 1:108 LA CASA VIA # 106
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-3013
Mailing Address - Country:US
Mailing Address - Phone:925-464-7278
Mailing Address - Fax:925-464-1318
Practice Address - Street 1:108 LA CASA VIA # 106
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3013
Practice Address - Country:US
Practice Address - Phone:925-464-7278
Practice Address - Fax:925-464-1318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-04
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA79371OtherMEDICAL BOARD OF CALIFORNIA