Healthcare Provider Details

I. General information

NPI: 1518003268
Provider Name (Legal Business Name): SHARON ROTH OMD, LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 08/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 S RAINBOW BLVD STE 22
LAS VEGAS NV
89145-5371
US

IV. Provider business mailing address

8424 DRY CLIFF CIR
LAS VEGAS NV
89128-7155
US

V. Phone/Fax

Practice location:
  • Phone: 702-259-6996
  • Fax: 702-259-6995
Mailing address:
  • Phone: 702-259-6996
  • Fax: 702-259-6995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number100
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number100
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: