Healthcare Provider Details

I. General information

NPI: 1770968000
Provider Name (Legal Business Name): MISAKO MCLEOD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2015
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PARK VISTA DR SUITE 3087
LAS VEGAS NV
89138-3026
US

IV. Provider business mailing address

100 PARK VISTA DR SUITE 3087
LAS VEGAS NV
89138-3026
US

V. Phone/Fax

Practice location:
  • Phone: 844-442-3668
  • Fax:
Mailing address:
  • Phone: 844-442-3668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number1107
License Number StateNV

VIII. Authorized Official

Name: MISAKO MCLEOD
Title or Position: OWNER
Credential: DPM
Phone: 415-302-0239