Healthcare Provider Details

I. General information

NPI: 1356095871
Provider Name (Legal Business Name): CHARLES DI LEONARDO MSPAS, PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2022
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3325 RESEARCH WAY
CARSON CITY NV
89706-7913
US

IV. Provider business mailing address

3325 RESEARCH WAY
CARSON CITY NV
89706-7913
US

V. Phone/Fax

Practice location:
  • Phone: 775-887-5140
  • Fax: 775-884-3618
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA-3033
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: