Healthcare Provider Details

I. General information

NPI: 1376879809
Provider Name (Legal Business Name): ROCKY VILLARAMA CFA/CST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2009
Last Update Date: 10/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1676 JUPITER CT SUITE D
LAS VEGAS NV
89119-5809
US

IV. Provider business mailing address

1676 JUPITER CT SUITE D
LAS VEGAS NV
89119-5809
US

V. Phone/Fax

Practice location:
  • Phone: 702-480-2867
  • Fax: 702-693-6595
Mailing address:
  • Phone: 702-480-2867
  • Fax: 702-693-6595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number112380
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number86492
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: