Provider Demographics
NPI:1679615033
Name:LUNTAYAO, ROSELLER RAFOL (LPT)
Entity type:Individual
Prefix:MR
First Name:ROSELLER
Middle Name:RAFOL
Last Name:LUNTAYAO
Suffix:
Gender:M
Credentials:LPT
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Mailing Address - Street 1:2001 THE ALAMEDA
Mailing Address - Street 2:ALLIANCE FOR COMMUNITY CARE
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-1136
Mailing Address - Country:US
Mailing Address - Phone:408-261-7777
Mailing Address - Fax:408-254-9960
Practice Address - Street 1:2001 THE ALAMEDA
Practice Address - Street 2:ALLIANCE FOR COMMUNITY CARE SERVICE TEAM ADULT OUTPATIE
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-1136
Practice Address - Country:US
Practice Address - Phone:408-261-7777
Practice Address - Fax:408-554-9960
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPT28077167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician