MEDICARE: ROZINA CALLOWAY

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	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1487109369
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROZINA CALLOWAY

Provider Business Mailing Address
First Line	:	3340 TOPAZ ST
Second Line	:	SUITE 170
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-3903
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3340 TOPAZ ST
Second Line	:	SUITE 170
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-3903
Country	:	US
Telephone Number	:	702-836-3118
Fax Number	:

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

Provider Enumeration Date	:	08/19/2016
Last Update Date	:	08/19/2016

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Directions to “ ROZINA CALLOWAY ” Practice Location

Language	Start Address	Practice Location

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