Healthcare Provider Details

I. General information

NPI: 1396664041
Provider Name (Legal Business Name): MARTIN ANTHONY JR LEON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6151 MOUNTAIN VISTA ST APT 1522
HENDERSON NV
89014-2361
US

IV. Provider business mailing address

9089 S PECOS RD STE 3400
HENDERSON NV
89074-7184
US

V. Phone/Fax

Practice location:
  • Phone: 840-220-7356
  • Fax:
Mailing address:
  • Phone: 702-867-5810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberBACB1617958
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: