MEDICARE: LESLIE FARBER,MD A MEDICAL CORPORATION

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
1	208D00000X	General Practice Physician	A38649	CA

General Provider Information

NPI Number	:	1609925247
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LESLIE FARBER,MD A MEDICAL CORPORATION

Provider Business Mailing Address
First Line	:	PO BOX 33704
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89133-3704
Country	:	US
Telephone Number	:	310-402-7484
Fax Number	:

Provider Business Practice Location Address
First Line	:	7575 W WASHINGTON AVE
Second Line	:	SUITE 127
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-4333
Country	:	US
Telephone Number	:	310-402-7484
Fax Number	:

Authorized Official
Title or Position	:	CEO,PHYSICIAN
Name	:	LESLIE FARBER
Credential	:	M.D.
Telephone Number	:	310-402-7484

Provider Enumeration Date	:	01/10/2007
Last Update Date	:	08/22/2020

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