MEDICARE: ROSA BELLOTA MD PC INC

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	2084P0800X	Psychiatry Physician
2	2084P0804X	Child & Adolescent Psychiatry Physician

General Provider Information

NPI Number	:	1891195988
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROSA BELLOTA MD PC INC

Provider Business Mailing Address
First Line	:	5940 S RAINBOW BLVD STE 2003
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-2540
Country	:	US
Telephone Number	:	702-987-6174
Fax Number	:	702-253-1468

Provider Business Practice Location Address
First Line	:	5940 S RAINBOW BLVD STE 2003
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-2540
Country	:	US
Telephone Number	:	702-987-6174
Fax Number	:	702-253-1468

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ROSA BELLOTA
Credential	:	MD
Telephone Number	:	702-987-6174

Provider Enumeration Date	:	08/26/2014
Last Update Date	:	08/26/2014

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