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General NPI Number Information
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NPI Number | 1932813557
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Entity Type | Organization
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Legal Business Name | ROSE ORCHID MEDICAL CENTER PC
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Dates
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Enumeration Date | 01/09/2023
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Last Update Date | 01/10/2023
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Provider Practice Location Address
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Address Line | 710 CORONADO CENTER DR STE 200
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City | HENDERSON
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State | NV
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Zip | 89052-4291
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Country | US
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Telephone | 702-622-0395
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Fax | 702-602-6800
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Provider Business Mailing Address
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Address Line | 710 CORONADO CENTER DR STE 200
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City | HENDERSON
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State | NV
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Zip | 89052-4291
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Country | US
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Telephone | 702-622-0395
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Fax | 702-602-6800
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | DR. SUPRIYA DASARI
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Credential | M.D
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Telephone | 510-825-2594
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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