Provider Demographics
NPI:1578084364
Name:DEL ROSARIO, RICHARD EVARISTO (PTA)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:EVARISTO
Last Name:DEL ROSARIO
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3783 PENEDOS DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-1089
Mailing Address - Country:US
Mailing Address - Phone:702-845-2987
Mailing Address - Fax:
Practice Address - Street 1:921 S HIGHWAY 160 STE 409
Practice Address - Street 2:
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89048-4682
Practice Address - Country:US
Practice Address - Phone:775-727-3838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-30
Last Update Date:2017-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVA-0926225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant