Provider Demographics
NPI:1326013764
Name:ROSENBERG, LISA JOY (MD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:JOY
Last Name:ROSENBERG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8025 AMIGO ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-1210
Mailing Address - Country:US
Mailing Address - Phone:702-380-8300
Mailing Address - Fax:702-380-8302
Practice Address - Street 1:8025 AMIGO ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-1210
Practice Address - Country:US
Practice Address - Phone:702-380-8300
Practice Address - Fax:702-380-8302
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2025-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11970207RG0300X, 207RH0002X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1326013764Medicaid
NV100510106Medicaid
NV100510106Medicaid
NVER069ZMedicare UPIN
NV102784Medicare PIN
NVV115238Medicare PIN