Provider Demographics
NPI:1740588722
Name:LONGORIA, ROLANDO (PA-C)
Entity Type:Individual
Prefix:MR
First Name:ROLANDO
Middle Name:
Last Name:LONGORIA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 S LOOP 499
Mailing Address - Street 2:STE 4
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-2519
Mailing Address - Country:US
Mailing Address - Phone:956-425-4386
Mailing Address - Fax:956-364-2103
Practice Address - Street 1:802 S LOOP 499
Practice Address - Street 2:STE 4
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-2519
Practice Address - Country:US
Practice Address - Phone:956-425-4386
Practice Address - Fax:956-364-2103
Is Sole Proprietor?:No
Enumeration Date:2011-03-01
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02612363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX341357702Medicaid
TX468868YLPSOtherWELLMED PTAN