Provider Demographics
NPI:1063882470
Name:LEPORI, DAVID W
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:W
Last Name:LEPORI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12104 ROSEMONT AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-5720
Mailing Address - Country:US
Mailing Address - Phone:505-379-8554
Mailing Address - Fax:505-247-9503
Practice Address - Street 1:12104 ROSEMONT AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-5720
Practice Address - Country:US
Practice Address - Phone:505-379-8554
Practice Address - Fax:505-247-9503
Is Sole Proprietor?:No
Enumeration Date:2015-09-28
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0146861101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)