Healthcare Provider Details

I. General information

NPI: 1093147472
Provider Name (Legal Business Name): LEILA D BERG PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2013
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 S ARLINGTON AVE
RENO NV
89501-2001
US

IV. Provider business mailing address

321 S ARLINGTON AVE
RENO NV
89501-2001
US

V. Phone/Fax

Practice location:
  • Phone: 775-235-8464
  • Fax: 775-260-2247
Mailing address:
  • Phone: 775-235-8464
  • Fax: 775-260-2247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA23108
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number23108
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA1672
License Number StateNV
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA1672
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: