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NPI Code Detail

MEDICARE: REBECCA J BOSCALJON MD

MEDICARE: REBECCA J BOSCALJON MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics Physician23439NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1023095379
Entity Type Code : Individual
Provider Name (Legal Business Name) : REBECCA J BOSCALJON MD
Provider Business Mailing Address
First Line : 3201 S MARYLAND PKWY STE 608
Second Line :
City : LAS VEGAS
State : NV
Zip : 89109-2428
Country : US
Telephone Number : 702-457-5437
Fax Number : 702-464-5801
Provider Business Practice Location Address
First Line : 3201 S MARYLAND PKWY STE 608
Second Line :
City : LAS VEGAS
State : NV
Zip : 89109-2428
Country : US
Telephone Number : 702-457-5437
Fax Number : 702-464-5801
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/28/2005
Last Update Date : 12/08/2025

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Directions to “ REBECCA J BOSCALJON MD” Practice Location

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