Provider Demographics
NPI:1184328502
Name:MENODIADO, ROALD BAUTISTA (DO, MPH)
Entity type:Individual
Prefix:DR
First Name:ROALD
Middle Name:BAUTISTA
Last Name:MENODIADO
Suffix:
Gender:M
Credentials:DO, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11054 WARATH OAK CT
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77065-5490
Mailing Address - Country:US
Mailing Address - Phone:832-488-2843
Mailing Address - Fax:
Practice Address - Street 1:7200 CAMBRIDGE ST FL 9
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4202
Practice Address - Country:US
Practice Address - Phone:713-798-6151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-29
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program