Provider Demographics
NPI:1528473501
Name:SANTELLANA, ROLANDO R
Entity type:Individual
Prefix:
First Name:ROLANDO
Middle Name:R
Last Name:SANTELLANA
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:PO BOX 1177
Mailing Address - Street 2:
Mailing Address - City:CONVERSE
Mailing Address - State:TX
Mailing Address - Zip Code:78109-4177
Mailing Address - Country:US
Mailing Address - Phone:210-447-7058
Mailing Address - Fax:210-447-7120
Practice Address - Street 1:12602 TOEPPERWEIN RD STE 205
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-3271
Practice Address - Country:US
Practice Address - Phone:210-447-7058
Practice Address - Fax:210-447-7120
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-27
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2283213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty