Healthcare Provider Details

I. General information

NPI: 1245691450
Provider Name (Legal Business Name): MARIO ROLDAN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2016
Last Update Date: 01/16/2025
Certification Date: 01/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

236 SAN JOSE ST
SALINAS CA
93901-3901
US

IV. Provider business mailing address

100 WILSON RD STE 100
MONTEREY CA
93940-7885
US

V. Phone/Fax

Practice location:
  • Phone: 831-424-7389
  • Fax:
Mailing address:
  • Phone: 831-242-8301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number20A19064
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: