Provider Demographics
NPI:1629570262
Name:ROLON MEDICAL PLLC
Entity Type:Organization
Organization Name:ROLON MEDICAL PLLC
Other - Org Name:ROLON MEDICAL PLLC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:JOSE
Authorized Official - Last Name:ROLON RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-300-9396
Mailing Address - Street 1:7680 LOWER GATEWAY LOOP UNIT 518
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32827-7195
Mailing Address - Country:US
Mailing Address - Phone:787-300-9396
Mailing Address - Fax:
Practice Address - Street 1:7680 LOWER GATEWAY LOOP UNIT 518
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32827-7195
Practice Address - Country:US
Practice Address - Phone:787-300-9396
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-28
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL130170207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty