Healthcare Provider Details

I. General information

NPI: 1790335131
Provider Name (Legal Business Name): LEILANI PAZ GADOR-MARCELINO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LEILANI PAZ GADOR

II. Dates (important events)

Enumeration Date: 09/18/2019
Last Update Date: 12/17/2020
Certification Date: 12/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 MALL RING CIR STE 202
HENDERSON NV
89014-6667
US

IV. Provider business mailing address

6588 BAROQUE AVE
LAS VEGAS NV
89139-6738
US

V. Phone/Fax

Practice location:
  • Phone: 702-768-1078
  • Fax:
Mailing address:
  • Phone: 702-339-8872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number819631
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: