Healthcare Provider Details

I. General information

NPI: 1891195988
Provider Name (Legal Business Name): ROSA BELLOTA MD PC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2014
Last Update Date: 08/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5940 S RAINBOW BLVD STE 2003
LAS VEGAS NV
89118-2540
US

IV. Provider business mailing address

5940 S RAINBOW BLVD STE 2003
LAS VEGAS NV
89118-2540
US

V. Phone/Fax

Practice location:
  • Phone: 702-987-6174
  • Fax: 702-253-1468
Mailing address:
  • Phone: 702-987-6174
  • Fax: 702-253-1468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: ROSA BELLOTA
Title or Position: PRESIDENT
Credential: MD
Phone: 702-987-6174