Healthcare Provider Details

I. General information

NPI: 1104841824
Provider Name (Legal Business Name): ROBERT C ROLLINS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 03/09/2022
Certification Date: 03/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3131 LA CANADA ST STE 230
LAS VEGAS NV
89169-2551
US

IV. Provider business mailing address

3131 LA CANADA ST STE 230
LAS VEGAS NV
89169-2551
US

V. Phone/Fax

Practice location:
  • Phone: 702-732-1290
  • Fax: 702-732-1385
Mailing address:
  • Phone: 702-732-1290
  • Fax: 702-732-1385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number11764
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: