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General NPI Number Information
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NPI Number | 1124740410
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Entity Type | Individual
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Provider Name | GERALD ROLIZ MSACN
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Gender | Male
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Dates
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Enumeration Date | 09/14/2022
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Last Update Date | 10/30/2024
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Provider Practice Location Address
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Address Line | 3715 E OVERLAND RD STE 220
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City | MERIDIAN
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State | ID
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Zip | 83642-8301
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Country | US
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Telephone | 208-918-1832
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Fax |
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Provider Business Mailing Address
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Address Line | 371 W REDGRAVE DR
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City | MERIDIAN
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State | ID
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Zip | 83646-0012
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Country | US
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Telephone | 208-906-8883
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number |
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License Number State |
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