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General NPI Number Information
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NPI Number | 1356095871
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Entity Type | Individual
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Provider Name | CHARLES DI LEONARDO MSPAS, PA-C
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Gender | Male
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Dates
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Enumeration Date | 02/04/2022
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Last Update Date | 11/20/2025
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Provider Practice Location Address
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Address Line | 1690 E AMARGOSA FARM RD
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City | AMARGOSA VALLEY
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State | NV
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Zip | 89020-9735
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Country | US
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Telephone | 775-372-5432
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Fax | 775-372-1303
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Provider Business Mailing Address
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Address Line | 3325 RESEARCH WAY
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City | CARSON CITY
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State | NV
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Zip | 89706-7913
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Country | US
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Telephone |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA-3033
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License Number State | NV
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