=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184629230
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LESLIE A GREENBERG MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/16/2005
-----------------------------------------------------
Last Update Date | 02/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 745 W MOANA LN
-----------------------------------------------------
City | RENO
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89509-4991
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-982-1000
-----------------------------------------------------
Fax | 775-984-8046
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1155 MILL ST MS M-14
-----------------------------------------------------
City | RENO
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89502-1576
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-982-5262
-----------------------------------------------------
Fax | 775-982-8046
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 0426388
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 15871
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------