# JOHNATHON CURTIS ROLLO

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1104185644
- **Gender:** Man
- **Credential:** MD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2086S0129X | Vascular Surgery Physician | A130427 | CA | Yes |
| 2086S0129X | Vascular Surgery Physician | MD60748391 | WA | — |

## Other

- **Enumeration date:** 05/03/2012
- **Last updated:** 09/02/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1104185644 | — | WA |
| 01 | — | 8967381 | MEDICARE PIN | WA |