Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 814-946 | NV |
NPI | 1013484096 |
---|---|
Provider Name | Riza Barraquias Leong |
First Address | Las Vegas, NV 89122-8661 |
Second Address | Las Vegas, NV 89122-8661 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/10/2018 |
Last Update Date | 29/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
814-946 | NURSE PRACTITIONER LICENSE (01) | NV |