Provider Demographics
NPI:1356938955
Name:TAMARIT MEDINA, ROGER RAMON
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:RAMON
Last Name:TAMARIT MEDINA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6141 VISTA VERDE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-1105
Mailing Address - Country:US
Mailing Address - Phone:702-773-7110
Mailing Address - Fax:
Practice Address - Street 1:2350 S JONES BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-3103
Practice Address - Country:US
Practice Address - Phone:702-510-9982
Practice Address - Fax:702-920-8270
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider