Healthcare Provider Details

I. General information

NPI: 1427825462
Provider Name (Legal Business Name): REY PLASABAS ROFEROS AGPCNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2023
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3015 HIGHWAY 95 STE 105
BULLHEAD CITY AZ
86442-4334
US

IV. Provider business mailing address

3015 HWAY 95 STE 105
BULLHEAD CITY AZ
86442-4334
US

V. Phone/Fax

Practice location:
  • Phone: 928-763-2001
  • Fax: 928-763-2038
Mailing address:
  • Phone: 928-763-2001
  • Fax: 928-763-2038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number11029993
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number324183
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: