Provider Demographics
NPI:1962975037
Name:ESTEVEZ, ROGERS
Entity type:Individual
Prefix:
First Name:ROGERS
Middle Name:
Last Name:ESTEVEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8330 COYADO ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-4321
Mailing Address - Country:US
Mailing Address - Phone:702-499-0251
Mailing Address - Fax:
Practice Address - Street 1:2800 S EASTERN AVE APT 1216
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-1872
Practice Address - Country:US
Practice Address - Phone:702-675-0574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-10
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant