Provider Demographics
NPI:1104338797
Name:PEREZ TOSCA, ROLANDO JULIAN (SA-C)
Entity type:Individual
Prefix:
First Name:ROLANDO
Middle Name:JULIAN
Last Name:PEREZ TOSCA
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2430 CENTERGATE DR APT 205
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-7289
Mailing Address - Country:US
Mailing Address - Phone:305-338-9333
Mailing Address - Fax:
Practice Address - Street 1:2430 CENTERGATE DR APT 205
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-7289
Practice Address - Country:US
Practice Address - Phone:305-338-9333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-03
Last Update Date:2017-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL17-593246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant