Provider Demographics
NPI:1083501142
Name:ROJO LOBO, ROLANDO JOSE (PA)
Entity type:Individual
Prefix:
First Name:ROLANDO
Middle Name:JOSE
Last Name:ROJO LOBO
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26800 N 27TH AVE UNIT 181
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085-0067
Mailing Address - Country:US
Mailing Address - Phone:602-818-2661
Mailing Address - Fax:
Practice Address - Street 1:26800 N 27TH AVE UNIT 181
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85085-0067
Practice Address - Country:US
Practice Address - Phone:602-818-2661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-21
Last Update Date:2025-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR002460363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical