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General NPI Number Information
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NPI Number | 1578012068
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Entity Type | Individual
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Provider Name | LESLIE MOYA
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Gender | Female
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Dates
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Enumeration Date | 09/26/2016
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Last Update Date | 09/26/2016
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Provider Practice Location Address
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Address Line | 3195 MILL ST
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City | RENO
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State | NV
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Zip | 89502-2201
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Country | US
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Telephone | 775-410-7832
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Fax |
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Provider Business Mailing Address
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Address Line | 749 PUTNAM DR
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City | RENO
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State | NV
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Zip | 89503-5906
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Country | US
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Telephone | 775-323-2627
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 0475
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License Number State | NV
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