Healthcare Provider Details

I. General information

NPI: 1457662611
Provider Name (Legal Business Name): DR. JOAN S. LEAKS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2010
Last Update Date: 06/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 E CALVADA BLVD SUITE 500
PAHRUMP NV
89048-6576
US

IV. Provider business mailing address

2080 E CALVADA BLVD SUITE 500
PAHRUMP NV
89048-6576
US

V. Phone/Fax

Practice location:
  • Phone: 775-751-2100
  • Fax: 775-751-2111
Mailing address:
  • Phone: 775-751-2100
  • Fax: 775-751-2111

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: 775-751-2100