Provider Demographics
NPI:1740862838
Name:GERENA, ROLANDO GABRIEL
Entity type:Individual
Prefix:
First Name:ROLANDO
Middle Name:GABRIEL
Last Name:GERENA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 W MAIN ST APT 215
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-1585
Mailing Address - Country:US
Mailing Address - Phone:786-417-1790
Mailing Address - Fax:
Practice Address - Street 1:1633 N CAPITOL AVE STE 640
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1281
Practice Address - Country:US
Practice Address - Phone:317-962-8881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-27
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program