Individual
DR. ROLAND JAYSON FORMOSO PUA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9460 W FLAMINGO RD, SUITE 120, LAS VEGAS, NV 89147-5742
(702) 638-7705
(702) 638-7706
Mailing address
11794 LONGWORTH RD, LAS VEGAS, NV 89135-1323
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
12103
NV
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
15963
ID
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
67340
AZ
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
C175306
CA
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
MD202126
OR
Other
Enumeration date
11/13/2006
Last updated
01/29/2024
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