=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760805287
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | C ROOFIAN MD PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/04/2014
-----------------------------------------------------
Last Update Date | 02/04/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 500 N RAINBOW BLVD SUITE 300
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89107-1082
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-450-1717
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 500 N RAINBOW BLVD SUITE 300
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89107-1082
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-450-1717
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | CLAUDE ROOFIAN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 702-450-1717
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 14818
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------