Provider Demographics
NPI:1871225821
Name:SANTA ROSA MEDICAL CENTERS OF NEVADA, INC.
Entity Type:Organization
Organization Name:SANTA ROSA MEDICAL CENTERS OF NEVADA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SYED
Authorized Official - Middle Name:IRSHAD
Authorized Official - Last Name:PERVAIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-750-1990
Mailing Address - Street 1:4161 S EASTERN AVE STE B3
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-5483
Mailing Address - Country:US
Mailing Address - Phone:702-750-1900
Mailing Address - Fax:702-989-4755
Practice Address - Street 1:3249 W CRAIG RD STE 140
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-0789
Practice Address - Country:US
Practice Address - Phone:702-750-1900
Practice Address - Fax:702-989-4755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-28
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy