Provider Demographics
NPI:1861598435
Name:ATIENZA, ROLANDO R (MD)
Entity type:Individual
Prefix:
First Name:ROLANDO
Middle Name:R
Last Name:ATIENZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31464 MARLIN CT
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94587-2594
Mailing Address - Country:US
Mailing Address - Phone:510-477-0297
Mailing Address - Fax:
Practice Address - Street 1:27206 CALAROGA AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94545-4300
Practice Address - Country:US
Practice Address - Phone:510-887-4711
Practice Address - Fax:510-887-2470
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA79796207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH89919Medicare UPIN