Provider Demographics
NPI:1326396581
Name:HULUGALLE, ROSHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSHAN
Middle Name:
Last Name:HULUGALLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2487 EMERALD AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-3340
Mailing Address - Country:US
Mailing Address - Phone:702-739-7477
Mailing Address - Fax:
Practice Address - Street 1:2487 EMERALD AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-3340
Practice Address - Country:US
Practice Address - Phone:702-739-7477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-20
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3714174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist