Provider Demographics
NPI:1275153884
Name:MINOZA, ROSCELLE J (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:ROSCELLE
Middle Name:J
Last Name:MINOZA
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:10161 PARK RUN DR STE 150
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89145-8872
Mailing Address - Country:US
Mailing Address - Phone:702-748-9726
Mailing Address - Fax:702-608-8528
Practice Address - Street 1:1811 S RAINBOW BLVD STE 201
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-0855
Practice Address - Country:US
Practice Address - Phone:702-748-9726
Practice Address - Fax:702-608-8528
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-23
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV836471363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health