Provider Demographics
NPI:1861484024
Name:MORTERO, ROSENDO F (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSENDO
Middle Name:F
Last Name:MORTERO
Suffix:
Gender:M
Credentials:MD
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 400310
Mailing Address - Street 2:
Mailing Address - City:LV
Mailing Address - State:NV
Mailing Address - Zip Code:89140
Mailing Address - Country:US
Mailing Address - Phone:702-487-6510
Mailing Address - Fax:702-473-5455
Practice Address - Street 1:10120 S. EASTERN AVE., SUITE 130
Practice Address - Street 2:VALLEY ANESTHESIOLOGY CONSULTANTS
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052
Practice Address - Country:US
Practice Address - Phone:702-482-6510
Practice Address - Fax:702-473-5455
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9517207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV200211521Medicaid
NV200211521Medicaid
NVV104434Medicare PIN
NVH27025Medicare UPIN