Healthcare Provider Details

I. General information

NPI: 1689995714
Provider Name (Legal Business Name): DR. JOAN S. LEAKS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2010
Last Update Date: 06/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7272 PALMYRA AVE
LAS VEGAS NV
89117-3112
US

IV. Provider business mailing address

9484 W FLAMINGO RD SUITE 280
LAS VEGAS NV
89147-5744
US

V. Phone/Fax

Practice location:
  • Phone: 702-325-8713
  • Fax: 702-364-8414
Mailing address:
  • Phone: 702-325-8713
  • Fax: 702-364-8414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QB0002X
TaxonomyObesity Medicine (Family Medicine) Physician
License Number5178
License Number StateNV

VIII. Authorized Official

Name: DR. JOAN S. LEAKS
Title or Position: PRESIDENT AND OWNER
Credential: MD
Phone: 702-325-8713