Healthcare Provider Details

I. General information

NPI: 1528418647
Provider Name (Legal Business Name): LEONEL BORJON PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2016
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 E LAKE MEAD BLVD STE 317
NORTH LAS VEGAS NV
89030-7193
US

IV. Provider business mailing address

223 FULLERTON AVE
HENDERSON NV
89015-5254
US

V. Phone/Fax

Practice location:
  • Phone: 702-960-4150
  • Fax: 702-960-4154
Mailing address:
  • Phone: 714-757-0537
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: