Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | E4334 | CA |
Y | 222Z00000X | Podiatrist | E4334 | CA |
NPI | 1003966805 |
---|---|
Provider Name | Brian A. Roling |
First Address | Oakland, CA 94612-3466 |
Second Address | Redwood City, CA 94063-2037 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2007 |
Last Update Date | 22/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000E43340 | (05) | CA |
U86292 | (02) |