Healthcare Provider Details

I. General information

NPI: 1881925139
Provider Name (Legal Business Name): MR. ROLANDO SAMANO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2010
Last Update Date: 01/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE PRIMERA #267 ENTRE NARDOS Y ROSAS. COL. JARDIN
H. MARAMOROS TAMAULIPAS
87330
MX

IV. Provider business mailing address

1445 E. MADISON ST. SUITE #201
BROWNSVILLE TX
78520
US

V. Phone/Fax

Practice location:
  • Phone: 956-465-4231
  • Fax: 956-465-4228
Mailing address:
  • Phone: 956-465-4231
  • Fax: 956-465-4228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number001733541
License Number StateZZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: