Provider Demographics
NPI:1134757990
Name:ROOSE, ALIS SERGEEVNA-SOKOLOVA (DO)
Entity type:Individual
Prefix:
First Name:ALIS
Middle Name:SERGEEVNA-SOKOLOVA
Last Name:ROOSE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3325 RESEARCH WAY
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89706-7913
Mailing Address - Country:US
Mailing Address - Phone:702-220-9902
Mailing Address - Fax:
Practice Address - Street 1:98 E LAKE MEAD PKWY STE 103
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015-6443
Practice Address - Country:US
Practice Address - Phone:702-868-0327
Practice Address - Fax:702-868-0290
Is Sole Proprietor?:No
Enumeration Date:2020-03-28
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVDO3473208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics