Healthcare Provider Details

I. General information

NPI: 1205866381
Provider Name (Legal Business Name): JOHN LEPORE DO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10105 BANBURRY CROSS DR SUITE 170
LAS VEGAS NV
89144-6646
US

IV. Provider business mailing address

10105 BANBURRY CROSS DR SUITE 170
LAS VEGAS NV
89144-6646
US

V. Phone/Fax

Practice location:
  • Phone: 702-765-5437
  • Fax: 702-240-7268
Mailing address:
  • Phone: 702-765-5437
  • Fax: 702-240-7268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JOHN LEPORE
Title or Position: PRESIDENT
Credential: DO
Phone: 702-765-5437