Provider Demographics
NPI:1669930558
Name:BRANLY, ROLANDO MANUEL (MBBS, SCD)
Entity type:Individual
Prefix:DR
First Name:ROLANDO
Middle Name:MANUEL
Last Name:BRANLY
Suffix:
Gender:M
Credentials:MBBS, SCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 SW 67TH TER
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-3227
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4201 SW 67TH TER
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33314-3227
Practice Address - Country:US
Practice Address - Phone:954-604-9705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-09
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHSE27982246QH0600X
OK35874208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No246QH0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyHistology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL27982OtherREGISTRATION NUMBER