Provider Demographics
NPI:1053095497
Name:ROTELLI, RANIERI ANTHONY
Entity type:Individual
Prefix:
First Name:RANIERI
Middle Name:ANTHONY
Last Name:ROTELLI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3444 KEARNY VILLA RD STE 401
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1964
Mailing Address - Country:US
Mailing Address - Phone:858-616-6400
Mailing Address - Fax:
Practice Address - Street 1:3444 KEARNY VILLA RD STE 401
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1964
Practice Address - Country:US
Practice Address - Phone:858-616-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA93659225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist