MEDICARE: DR. VICTOR ATIENZA DE LEON M.D.

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	207Q00000X	Family Medicine Physician	9215	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	710984126	OTHER	NV	TAX IDENTIFICATION NUMBER
2	NV9215	OTHER	NV	STATE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861564783
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VICTOR ATIENZA DE LEON M.D.

Provider Business Mailing Address
First Line	:	3131 W CHARLESTON BLVD
Second Line	:	STE. 150
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-1979
Country	:	US
Telephone Number	:	702-878-2801
Fax Number	:	702-878-3050

Provider Business Practice Location Address
First Line	:	3009 W CHARLESTON BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-1943
Country	:	US
Telephone Number	:	702-878-2801
Fax Number	:	702-877-6711

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2006
Last Update Date	:	08/21/2013

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