Healthcare Provider Details

I. General information

NPI: 1609988922
Provider Name (Legal Business Name): EVELYN DELROSARIO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 03/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8352 W WARM SPRINGS RD STE 210
LAS VEGAS NV
89113-3630
US

IV. Provider business mailing address

8352 W WARM SPRINGS RD STE 210
LAS VEGAS NV
89113-3630
US

V. Phone/Fax

Practice location:
  • Phone: 702-944-4028
  • Fax: 702-944-4019
Mailing address:
  • Phone: 702-944-4028
  • Fax: 702-944-4019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301054643
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number15516
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: