Healthcare Provider Details

I. General information

NPI: 1235499922
Provider Name (Legal Business Name): ROTEM ELITSUR-FITZPATRICK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2012
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4797 CAUGHLIN PKWY STE 110
RENO NV
89519-1013
US

IV. Provider business mailing address

4797 CAUGHLIN PKWY STE 110
RENO NV
89519-1013
US

V. Phone/Fax

Practice location:
  • Phone: 775-322-1880
  • Fax: 775-322-1808
Mailing address:
  • Phone: 775-322-1880
  • Fax: 775-322-1808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35136841
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number35136841
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: