Healthcare Provider Details

I. General information

NPI: 1033040027
Provider Name (Legal Business Name): ROSA ALICIA SAMUEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7900 PANDORA SKY ST UNIT 3
NORTH LAS VEGAS NV
89084-3032
US

IV. Provider business mailing address

7900 PANDORA SKY ST UNIT 3
NORTH LAS VEGAS NV
89084-3032
US

V. Phone/Fax

Practice location:
  • Phone: 760-216-0511
  • Fax:
Mailing address:
  • Phone: 760-216-0511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateNV
# 4
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number StateNV
# 5
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNV
# 6
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNV
# 7
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: