Provider Demographics
NPI:1912051483
Name:OSTOLAZA, ROBERTO (DC)
Entity Type:Individual
Prefix:
First Name:ROBERTO
Middle Name:
Last Name:OSTOLAZA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3620 E FLAMINGO RD
Mailing Address - Street 2:SUITE 7 & 8
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-4935
Mailing Address - Country:US
Mailing Address - Phone:702-318-3344
Mailing Address - Fax:702-318-3345
Practice Address - Street 1:3620 E FLAMINGO RD
Practice Address - Street 2:SUITE 7 & 8
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-4935
Practice Address - Country:US
Practice Address - Phone:702-318-3344
Practice Address - Fax:702-318-3345
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB00819111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician