Provider Demographics
NPI:1366810889
Name:FULGENCIO, ROLANDO (ND)
Entity type:Individual
Prefix:DR
First Name:ROLANDO
Middle Name:
Last Name:FULGENCIO
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3480 S 152ND ST
Mailing Address - Street 2:
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98188-2142
Mailing Address - Country:US
Mailing Address - Phone:206-244-5216
Mailing Address - Fax:
Practice Address - Street 1:3480 S 152ND ST
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-2142
Practice Address - Country:US
Practice Address - Phone:206-244-5216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-15
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT60570489207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine