Provider Demographics
NPI:1932889250
Name:AVELAR, ROGELIO DANIEL
Entity type:Individual
Prefix:
First Name:ROGELIO
Middle Name:DANIEL
Last Name:AVELAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9071 BONITA BEACH RD SE STE 1389
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34135-4213
Mailing Address - Country:US
Mailing Address - Phone:239-429-0100
Mailing Address - Fax:
Practice Address - Street 1:9400 BONITA BEACH RD SE
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135-4520
Practice Address - Country:US
Practice Address - Phone:239-434-8565
Practice Address - Fax:239-799-4955
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-21
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11027541363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily