MEDICARE: ROSCELLE J MINOZA PMHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	836471	NV

General Provider Information

NPI Number	:	1275153884
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSCELLE J MINOZA PMHNP-BC

Provider Business Mailing Address
First Line	:	10161 PARK RUN DR STE 150
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89145-8872
Country	:	US
Telephone Number	:	702-748-9726
Fax Number	:	702-608-8528

Provider Business Practice Location Address
First Line	:	1811 S RAINBOW BLVD STE 201
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-0855
Country	:	US
Telephone Number	:	702-748-9726
Fax Number	:	702-608-8528

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/23/2020
Last Update Date	:	03/01/2023

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