Provider Demographics
NPI:1205454295
Name:ROSALES PONCE DE LEON, AMAURI SANTIAGO (APRN-CNP)
Entity type:Individual
Prefix:
First Name:AMAURI
Middle Name:SANTIAGO
Last Name:ROSALES PONCE DE LEON
Suffix:
Gender:M
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:546 N EASTERN AVE STE 140
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89101-3485
Mailing Address - Country:US
Mailing Address - Phone:702-778-7614
Mailing Address - Fax:702-778-7615
Practice Address - Street 1:546 N EASTERN AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89101-3481
Practice Address - Country:US
Practice Address - Phone:702-778-7614
Practice Address - Fax:702-778-7615
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-07
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV841192163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse