Provider Demographics
NPI:1023489978
Name:ROLAND, TISA DENE (LAC)
Entity type:Individual
Prefix:MS
First Name:TISA
Middle Name:DENE
Last Name:ROLAND
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 AUBURN ST
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-2601
Mailing Address - Country:US
Mailing Address - Phone:209-559-1246
Mailing Address - Fax:
Practice Address - Street 1:139 AUBURN ST
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-2601
Practice Address - Country:US
Practice Address - Phone:209-559-1246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-16
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13654171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist