Provider Demographics
NPI:1902404379
Name:VIDAL SARMIENTO, ROSA LINDA
Entity Type:Individual
Prefix:MRS
First Name:ROSA
Middle Name:LINDA
Last Name:VIDAL SARMIENTO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ROSA
Other - Middle Name:LINDA
Other - Last Name:VIDAL SARMIENTO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5020 ALTA DR SUIT-B
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107
Mailing Address - Country:US
Mailing Address - Phone:702-685-3478
Mailing Address - Fax:702-947-4688
Practice Address - Street 1:5020 ALTA DR SUIT-B
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107
Practice Address - Country:US
Practice Address - Phone:702-685-3418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-16
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant