MEDICARE: SANTA ROSA MEDICAL CENTERS OF NEVADA, INC.

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
1	3336H0001X	Home Infusion Therapy Pharmacy
2	3336C0002X	Clinic Pharmacy

General Provider Information

NPI Number	:	1386376325
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANTA ROSA MEDICAL CENTERS OF NEVADA, INC.

Provider Business Mailing Address
First Line	:	4161 S EASTERN AVE STE B3
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-5483
Country	:	US
Telephone Number	:	702-693-6222
Fax Number	:	702-369-6504

Provider Business Practice Location Address
First Line	:	2670 N LAS VEGAS BLVD STE 109
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-5871
Country	:	US
Telephone Number	:	702-399-0607
Fax Number	:

Authorized Official
Title or Position	:	MANAGING DIRECTOR
Name	:	SYED IRSHAD PERVAIZ
Credential	:
Telephone Number	:	702-399-0604

Provider Enumeration Date	:	06/28/2022
Last Update Date	:	08/17/2022

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