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NPI Code Detail

MEDICARE: AMAURI SANTIAGO ROSALES PONCE DE LEON APRN-CNP

MEDICARE: AMAURI SANTIAGO ROSALES PONCE DE LEON APRN-CNP
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
1163W00000XRegistered Nurse841192NV
2363LF0000XFamily Nurse Practitioner841192NV

General Provider Information

NPI Number : 1205454295
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMAURI SANTIAGO ROSALES PONCE DE LEON APRN-CNP
Provider Business Mailing Address
First Line : 546 N EASTERN AVE STE 140
Second Line :
City : LAS VEGAS
State : NV
Zip : 89101-3485
Country : US
Telephone Number : 702-778-7614
Fax Number : 702-778-7615
Provider Business Practice Location Address
First Line : 3430 E FLAMINGO RD STE 104
Second Line :
City : LAS VEGAS
State : NV
Zip : 89121-5070
Country : US
Telephone Number : 702-703-9070
Fax Number : 702-977-4760
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2020
Last Update Date : 02/28/2026

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Directions to “ AMAURI SANTIAGO ROSALES PONCE DE LEON APRN-CNP” Practice Location

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