Healthcare Provider Details

I. General information

NPI: 1366893927
Provider Name (Legal Business Name): ROLANDO MARCELLA SANTOS JR. FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2016
Last Update Date: 06/24/2020
Certification Date: 06/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 HOWE AVE STE 600
SACRAMENTO CA
95825-4797
US

IV. Provider business mailing address

729 SUNRISE AVE STE 611
ROSEVILLE CA
95661-4548
US

V. Phone/Fax

Practice location:
  • Phone: 916-953-7571
  • Fax: 916-771-8515
Mailing address:
  • Phone: 916-953-7571
  • Fax: 916-771-8515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95004444
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number95004444
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: