MEDICARE: MR. RYAN MICHAEL RODARTE

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	3747P1801X	Personal Care Attendant
2	364SH0200X	Home Health Clinical Nurse Specialist	2105320033	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285105940
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RYAN MICHAEL RODARTE

Provider Business Mailing Address
First Line	:	5020 ALTA DR STE B
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89107-3940
Country	:	US
Telephone Number	:	702-403-7999
Fax Number	:

Provider Business Practice Location Address
First Line	:	2665 S BRUCE ST APT 155
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89169-1757
Country	:	US
Telephone Number	:	702-686-0852
Fax Number	:

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

Provider Enumeration Date	:	12/06/2018
Last Update Date	:	08/05/2019

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