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Individual

JOHNNY JESUS ROSA JR.

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
1575 DELUCCHI LN STE 220, RENO, NV 89502-8521
(775) 825-7500
(775) 825-7500
Mailing address
1575 DELUCCHI LANE, #220, RENO, NV 89502
(775) 825-7500
(775) 825-7550

Taxonomy

Speciality
Code
Description
License number
State
225400000X
Rehabilitation Practitioner
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
225400000X
NV
Enumeration date
07/26/2017
Last updated
07/26/2017
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