Individual
JOHNATHON CURTIS ROLLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
200 UCLA MEDICAL PLZ STE 526, LOS ANGELES, CA 90095-8414
(310) 206-6294
Mailing address
5767 W CENTURY BLVD STE 400, LOS ANGELES, CA 90045-5631
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
A130427
CA
2086S0129X
Vascular Surgery Physician
MD60748391
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1104185644
—
WA
01
—
8967381
MEDICARE PIN
WA
Enumeration date
05/03/2012
Last updated
09/02/2021
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