Provider Demographics
NPI:1033365556
Name:ROSHAN RAJA DO PC
Entity Type:Organization
Organization Name:ROSHAN RAJA DO PC
Other - Org Name:CHILD NEUROLOGY SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROSHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RAJA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:702-715-0698
Mailing Address - Street 1:2821 W HORIZON RIDGE PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-4429
Mailing Address - Country:US
Mailing Address - Phone:702-920-0290
Mailing Address - Fax:702-789-1050
Practice Address - Street 1:2821 W HORIZON RIDGE PKWY STE 100
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052
Practice Address - Country:US
Practice Address - Phone:702-920-0290
Practice Address - Fax:702-789-1050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-15
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child NeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1033365556Medicaid