Healthcare Provider Details

I. General information

NPI: 1639257264
Provider Name (Legal Business Name): ROSHAN RAJA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 02/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2821 W HORIZON RIDGE PKWY STE. 100
HENDERSON NV
89052-4427
US

IV. Provider business mailing address

2821 W HORIZON RIDGE PKWY STE. 100
HENDERSON NV
89052-4427
US

V. Phone/Fax

Practice location:
  • Phone: 702-920-0290
  • Fax: 702-789-1050
Mailing address:
  • Phone: 702-920-0290
  • Fax: 702-789-1050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberDO1405
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: