Provider Demographics
NPI:1174641732
Name:GARCIA, ROLANDO (MD)
Entity type:Individual
Prefix:DR
First Name:ROLANDO
Middle Name:
Last Name:GARCIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13131 KINGS LAKE DR UNIT 101
Mailing Address - Street 2:
Mailing Address - City:GIBSONTON
Mailing Address - State:FL
Mailing Address - Zip Code:33534-3959
Mailing Address - Country:US
Mailing Address - Phone:813-672-6092
Mailing Address - Fax:813-677-1892
Practice Address - Street 1:13131 KINGS LAKE DR UNIT 101
Practice Address - Street 2:
Practice Address - City:GIBSONTON
Practice Address - State:FL
Practice Address - Zip Code:33534-3959
Practice Address - Country:US
Practice Address - Phone:813-672-6092
Practice Address - Fax:813-677-1892
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME98642208000000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
208910483OtherTRICARE
5019130OtherCIGNA
02131OtherBCBS
FL279991000Medicaid
FLME98642OtherFLORIDA MEDICAL LICENSE
12-07507OtherUNITED HEALTH
FLME98642OtherMEDICAL LICENSE
FL336427OtherAMERIGROUP
FL004092500Medicaid
9826103OtherAETNA
NVLL1705OtherMEDICAL LICENSE
NVLL1705OtherMEDICAL LICENSE