Provider Demographics
NPI:1093181307
Name:REBOLLO RODRIGUEZ, NICOLE PAOLA (MD)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:PAOLA
Last Name:REBOLLO RODRIGUEZ
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5750 CENTRE AVE STE 230
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15206-3761
Mailing Address - Country:US
Mailing Address - Phone:412-681-4220
Mailing Address - Fax:412-681-4396
Practice Address - Street 1:5750 CENTRE AVE STE 230
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15206-3761
Practice Address - Country:US
Practice Address - Phone:412-681-4220
Practice Address - Fax:412-681-4396
Is Sole Proprietor?:No
Enumeration Date:2015-08-20
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD485635207W00000X, 207WX0200X
PR34866208D00000X
390200000X
TN63037207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Yes207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive Surgery
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program