Healthcare Provider Details

I. General information

NPI: 1750356051
Provider Name (Legal Business Name): DAVID DANIEL ROTENBERG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 11/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 E DESERT INN RD STE 100
LAS VEGAS NV
89121-3609
US

IV. Provider business mailing address

2800 E DESERT INN RD STE 100
LAS VEGAS NV
89121-3609
US

V. Phone/Fax

Practice location:
  • Phone: 702-731-1616
  • Fax: 702-731-0741
Mailing address:
  • Phone: 702-731-1616
  • Fax: 702-731-0741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberG88986
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG88986
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number15100
License Number StateNV
# 4
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number15100
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: