Provider Demographics
NPI:1790271120
Name:PERAZA, ROSA AMELIA
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:AMELIA
Last Name:PERAZA
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 1:2575 S CIMARRON RD STE 201
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-2682
Mailing Address - Country:US
Mailing Address - Phone:702-635-9900
Mailing Address - Fax:
Practice Address - Street 1:2575 S CIMARRON RD STE 201
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-2682
Practice Address - Country:US
Practice Address - Phone:702-635-9900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-09
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2104086296OtherDL