Provider Demographics
NPI:1124740410
Name:ROLIZ, GERALD (MSACN)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:
Last Name:ROLIZ
Suffix:
Gender:M
Credentials:MSACN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:371 W REDGRAVE DR
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-0012
Mailing Address - Country:US
Mailing Address - Phone:208-906-8883
Mailing Address - Fax:
Practice Address - Street 1:3715 E OVERLAND RD STE 220
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-8301
Practice Address - Country:US
Practice Address - Phone:208-918-1832
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-14
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist