Provider Demographics
NPI:1043016967
Name:REBOLLOSA, ADOLFO ELIAS
Entity type:Individual
Prefix:
First Name:ADOLFO
Middle Name:ELIAS
Last Name:REBOLLOSA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 W HERON ST
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:WA
Mailing Address - Zip Code:98520-6022
Mailing Address - Country:US
Mailing Address - Phone:564-544-1944
Mailing Address - Fax:
Practice Address - Street 1:511 W HERON ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:WA
Practice Address - Zip Code:98520-6022
Practice Address - Country:US
Practice Address - Phone:564-544-1944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-21
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO61324333101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)