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General NPI Number Information
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NPI Number | 1629047881
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Entity Type | Individual
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Provider Name | LEINI-LUCK PENA MD
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Gender | Male
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Dates
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Enumeration Date | 03/17/2006
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Last Update Date | 10/28/2014
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Provider Practice Location Address
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Address Line | 3186 S MARYLAND PKWY
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City | LAS VEGAS
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State | NV
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Zip | 89109
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Country | US
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Telephone | 702-731-8099
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Fax | 702-731-8292
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Provider Business Mailing Address
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Address Line | 3196 S MARYLAND PKWY STE 101
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City | LAS VEGAS
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State | NV
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Zip | 89109
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Country | US
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Telephone | 702-731-8099
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Fax | 702-731-8292
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 10387
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License Number State | NV
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