Provider Demographics
NPI:1669211090
Name:CARBONELL, ROLANDO ROMUA JR (RN)
Entity type:Individual
Prefix:
First Name:ROLANDO
Middle Name:ROMUA
Last Name:CARBONELL
Suffix:JR
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4595 AMIENS AVE
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94555-2517
Mailing Address - Country:US
Mailing Address - Phone:510-552-0043
Mailing Address - Fax:
Practice Address - Street 1:1850 FAIRWAY DR
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-5629
Practice Address - Country:US
Practice Address - Phone:510-746-4550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-24
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95140314163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse