Healthcare Provider Details

I. General information

NPI: 1932813557
Provider Name (Legal Business Name): ROSE ORCHID MEDICAL CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2023
Last Update Date: 01/10/2023
Certification Date: 01/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 CORONADO CENTER DR STE 200
HENDERSON NV
89052-4291
US

IV. Provider business mailing address

710 CORONADO CENTER DR STE 200
HENDERSON NV
89052-4291
US

V. Phone/Fax

Practice location:
  • Phone: 702-622-0395
  • Fax: 702-602-6800
Mailing address:
  • Phone: 702-622-0395
  • Fax: 702-602-6800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SUPRIYA DASARI
Title or Position: OWNER/PROVIDER
Credential: M.D
Phone: 510-825-2594