Provider Demographics
NPI:1376879809
Name:VILLARAMA, ROCKY (CFA/CST)
Entity Type:Individual
Prefix:
First Name:ROCKY
Middle Name:
Last Name:VILLARAMA
Suffix:
Gender:M
Credentials:CFA/CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1676 JUPITER CT
Mailing Address - Street 2:SUITE D
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-5809
Mailing Address - Country:US
Mailing Address - Phone:702-480-2867
Mailing Address - Fax:702-693-6595
Practice Address - Street 1:1676 JUPITER CT
Practice Address - Street 2:SUITE D
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5809
Practice Address - Country:US
Practice Address - Phone:702-480-2867
Practice Address - Fax:702-693-6595
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-17
Last Update Date:2009-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV112380246ZC0007X
NV86492246ZS0410X
NV247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other