MEDICARE: SANTA ROSA MEDICAL CENTERS OF NEVADA, 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	207R00000X	Internal Medicine Physician	11875	NV
2	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1912155110
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANTA ROSA MEDICAL CENTERS OF NEVADA, INC.

Provider Business Mailing Address
First Line	:	4161 S EASTERN AVE
Second Line	:	SUITE B3
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-5484
Country	:	US
Telephone Number	:	702-693-6222
Fax Number	:	702-369-6504

Provider Business Practice Location Address
First Line	:	4161 S EASTERN AVE
Second Line	:	SUITE B3
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-5484
Country	:	US
Telephone Number	:	702-693-6222
Fax Number	:	702-369-6504

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SYED I PERVAIZ
Credential	:	M.D.
Telephone Number	:	702-693-6222

Provider Enumeration Date	:	09/03/2008
Last Update Date	:	08/16/2022

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