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General NPI Number Information
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NPI Number | 1972109304
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Entity Type | Individual
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Provider Name | ROLANDO EMMANUEL PEREZ MENDEZ DC
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Gender | Male
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Dates
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Enumeration Date | 12/10/2020
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Last Update Date | 12/10/2020
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Provider Practice Location Address
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Address Line | 1008 PARK AVENUE ORANGE PARK SUITE
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City | JACKSONVILLE
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State | FL
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Zip | 32073
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Country | US
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Telephone | 904-375-9429
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Fax |
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Provider Business Mailing Address
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Address Line | 5609 VICTORIA GARDENS BLVD APT 1204
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City | PORT ORANGE
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State | FL
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Zip | 32127-8973
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Country | US
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Telephone | 787-383-8685
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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 | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 13321
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License Number State | FL
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