Healthcare Provider Details

I. General information

NPI: 1376458711
Provider Name (Legal Business Name): LEILANI ANGELINA GUTIERREZ LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3930 HOWARD HUGHES PKWY
LAS VEGAS NV
89169-0943
US

IV. Provider business mailing address

66 BACK SPIN CT
LAS VEGAS NV
89148-5240
US

V. Phone/Fax

Practice location:
  • Phone: 702-560-2192
  • Fax:
Mailing address:
  • Phone: 702-861-9961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number895443
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: