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General NPI Number Information
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NPI Number | 1457662611
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Entity Type | Organization
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Legal Business Name | DR. JOAN S. LEAKS, PC
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Dates
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Enumeration Date | 06/23/2010
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Last Update Date | 06/23/2010
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Provider Practice Location Address
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Address Line | 2080 E CALVADA BLVD SUITE 500
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City | PAHRUMP
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State | NV
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Zip | 89048-6576
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Country | US
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Telephone | 775-751-2100
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Fax | 775-751-2111
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Provider Business Mailing Address
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Address Line | 2080 E CALVADA BLVD SUITE 500
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City | PAHRUMP
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State | NV
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Zip | 89048-6576
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Country | US
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Telephone | 775-751-2100
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Fax | 775-751-2111
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Authorized Official
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Title or Position | PRESIDENT AND OWNER
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Name | DR. JOAN S. LEAKS
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Credential | MD
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Telephone | 775-751-2100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QB0002X
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Taxonomy Name | Obesity Medicine (Family Medicine) Physician
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License Number | 5178
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License Number State | NV
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