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General NPI Number Information
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NPI Number | 1134180839
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Entity Type | Individual
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Provider Name | LEONARDO ALDECOA GAN-LIM M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/31/2006
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Last Update Date | 03/15/2023
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Provider Practice Location Address
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Address Line | 653 N TOWN CENTER DR STE 101
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City | LAS VEGAS
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State | NV
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Zip | 89144-0515
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Country | US
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Telephone | 702-805-2435
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Fax | 702-485-2812
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Provider Business Mailing Address
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Address Line | 2654 TOPAZ BLUE ST
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City | LAS VEGAS
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State | NV
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Zip | 89146-5490
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Country | US
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Telephone | 702-461-2707
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | 10945
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License Number State | NV
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