Provider Demographics
NPI:1578952370
Name:RENTERIA, ROSALBA
Entity Type:Individual
Prefix:MRS
First Name:ROSALBA
Middle Name:
Last Name:RENTERIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 370971
Mailing Address - Street 2:330 VALLEY VIEW BOULEVARD LAS VEGAS NV 89107
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89137-0971
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:330 S VALLEY VIEW BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-4361
Practice Address - Country:US
Practice Address - Phone:702-557-3228
Practice Address - Fax:702-557-3228
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-16
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY246RP1900X, 261QA0600X, 283Q00000X
NV283Q00000X
NV279863163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No283Q00000XHospitalsPsychiatric Hospital