Provider Demographics
NPI:1194707307
Name:EBRON, ROSITA PENA (MD)
Entity type:Individual
Prefix:
First Name:ROSITA
Middle Name:PENA
Last Name:EBRON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6655 W PATRICK LN
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-2513
Mailing Address - Country:US
Mailing Address - Phone:702-871-9083
Mailing Address - Fax:
Practice Address - Street 1:1600 W SUNSET RD STE A
Practice Address - Street 2:CHILDREN'S URGENT CARE
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-2655
Practice Address - Country:US
Practice Address - Phone:702-898-6400
Practice Address - Fax:702-898-7032
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV7030208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics