Provider Demographics
NPI:1407383904
Name:DE VERA, ROMMEL (DO)
Entity Type:Individual
Prefix:
First Name:ROMMEL
Middle Name:
Last Name:DE VERA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2345 E PRATER WAY STE 207
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89434-9634
Mailing Address - Country:US
Mailing Address - Phone:702-867-9339
Mailing Address - Fax:702-640-5898
Practice Address - Street 1:5380 S RAINBOW BLVD STE 330
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-1880
Practice Address - Country:US
Practice Address - Phone:702-867-9339
Practice Address - Fax:702-640-5898
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-15
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVDO2659207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty