Healthcare Provider Details

I. General information

NPI: 1093181307
Provider Name (Legal Business Name): NICOLE PAOLA REBOLLO RODRIGUEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2015
Last Update Date: 03/14/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5750 CENTRE AVE STE 230
PITTSBURGH PA
15206-3761
US

IV. Provider business mailing address

5750 CENTRE AVE STE 230
PITTSBURGH PA
15206-3761
US

V. Phone/Fax

Practice location:
  • Phone: 412-681-4220
  • Fax: 412-681-4396
Mailing address:
  • Phone: 412-681-4220
  • Fax: 412-681-4396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD485635
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License NumberMD485635
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: