Provider Demographics
NPI:1336349588
Name:ROLISON, CARLA LEE (DOM)
Entity Type:Individual
Prefix:DR
First Name:CARLA
Middle Name:LEE
Last Name:ROLISON
Suffix:
Gender:F
Credentials:DOM
Other - Prefix:DR
Other - First Name:CARLA
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DOM
Mailing Address - Street 1:PO BOX 15535
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87174-0535
Mailing Address - Country:US
Mailing Address - Phone:505-804-8285
Mailing Address - Fax:
Practice Address - Street 1:7810 MENAUL BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-4604
Practice Address - Country:US
Practice Address - Phone:505-804-8285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-24
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM944171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist