Healthcare Provider Details

I. General information

NPI: 1053848689
Provider Name (Legal Business Name): JUSTIN ANDREW LEEKA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2017
Last Update Date: 06/26/2020
Certification Date: 06/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5380 S RAINBOW BLVD STE 330
LAS VEGAS NV
89118-1880
US

IV. Provider business mailing address

5380 S RAINBOW BLVD STE 330
LAS VEGAS NV
89118-1880
US

V. Phone/Fax

Practice location:
  • Phone: 702-382-8222
  • Fax: 702-640-0604
Mailing address:
  • Phone: 702-382-8222
  • Fax: 702-640-0604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberSL1202
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO26940
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: