1457478745 NPI number — DR. ROSLYN BERNADETTE WEINGARTEN MD

Table of content: DR. ROSLYN BERNADETTE WEINGARTEN MD (NPI 1457478745)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457478745 NPI number — DR. ROSLYN BERNADETTE WEINGARTEN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEINGARTEN
Provider First Name:
ROSLYN
Provider Middle Name:
BERNADETTE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TANNOURY
Provider Other First Name:
ROSLYN
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1457478745
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/26/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3144 BEACH VIEW CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89117-3531
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-300-5228
Provider Business Mailing Address Fax Number:
702-684-7469

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2001 S RAINBOW BLVD
Provider Second Line Business Practice Location Address:
SUITE 160
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89146-2990
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-315-4600
Provider Business Practice Location Address Fax Number:
702-315-4607
Provider Enumeration Date:
03/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  12311 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1457478745 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".




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