Provider Demographics
NPI:1306059050
Name:JUSTINIANI, ROLANDO MARAVILLA (BACHELOR OF SCIENCE)
Entity type:Individual
Prefix:MR
First Name:ROLANDO
Middle Name:MARAVILLA
Last Name:JUSTINIANI
Suffix:
Gender:M
Credentials:BACHELOR OF SCIENCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 18TH ST
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-2918
Mailing Address - Country:US
Mailing Address - Phone:310-546-4286
Mailing Address - Fax:
Practice Address - Street 1:1955 LOMITA BLVD
Practice Address - Street 2:
Practice Address - City:LOMITA
Practice Address - State:CA
Practice Address - Zip Code:90717-1807
Practice Address - Country:US
Practice Address - Phone:310-325-1970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20326225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist