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NPI Code Detail

MEDICARE: LEILA D BERG PA-C

MEDICARE: LEILA D BERG PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantPA1672NV
2363A00000XPhysician AssistantPA23108CA
3363AM0700XMedical Physician AssistantPA1672NV

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1V52366OTHERNVMEDICARE PTAN

General Provider Information

NPI Number : 1093147472
Entity Type Code : Individual
Provider Name (Legal Business Name) : LEILA D BERG PA-C
Provider Business Mailing Address
First Line : 889 S RAINBOW BLVD # 125
Second Line :
City : LAS VEGAS
State : NV
Zip : 89145-6238
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1825 E WARM SPRINGS RD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89119-4547
Country : US
Telephone Number : 702-361-4873
Fax Number : 702-838-0997
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/07/2013
Last Update Date : 01/18/2022

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Directions to “ LEILA D BERG PA-C” Practice Location

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