Healthcare Provider Details

I. General information

NPI: 1255063277
Provider Name (Legal Business Name): SANTA ROSA MEDICAL CENTERS OF NEVADA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2022
Last Update Date: 06/28/2022
Certification Date: 06/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4161 S EASTERN AVE STE B3
LAS VEGAS NV
89119-5483
US

IV. Provider business mailing address

4161 S EASTERN AVE STE B3
LAS VEGAS NV
89119-5483
US

V. Phone/Fax

Practice location:
  • Phone: 702-693-6222
  • Fax: 702-369-6504
Mailing address:
  • Phone: 702-693-6222
  • Fax: 702-369-6504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SYED IRSHAD PERVAIZ
Title or Position: MANAGING DIRECTOR
Credential:
Phone: 702-762-2592