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General NPI Number Information
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NPI Number | 1568454205
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Entity Type | Individual
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Provider Name | ROLLO P VILLAREAL MD
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Gender | Male
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Dates
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Enumeration Date | 08/18/2005
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Last Update Date | 12/14/2021
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Provider Practice Location Address
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Address Line | 421 EPTING AVE
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City | GREENWOOD
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State | SC
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Zip | 29646-4041
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Country | US
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Telephone | 864-227-6818
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Fax | 864-227-0850
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Provider Business Mailing Address
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Address Line | 421 EPTING AVE
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City | GREENWOOD
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State | SC
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Zip | 29646-4041
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Country | US
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Telephone | 864-227-6818
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Fax | 864-227-0850
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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 | 207RC0001X
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Taxonomy Name | Clinical Cardiac Electrophysiology Physician
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License Number | 23754
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 23754
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License Number State | SC
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