Provider Demographics
NPI:1861564783
Name:DE LEON, VICTOR ATIENZA (MD)
Entity type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:ATIENZA
Last Name:DE LEON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3131 W CHARLESTON BLVD
Mailing Address - Street 2:STE. 150
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-1979
Mailing Address - Country:US
Mailing Address - Phone:702-878-2801
Mailing Address - Fax:702-878-3050
Practice Address - Street 1:3009 W CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1943
Practice Address - Country:US
Practice Address - Phone:702-878-2801
Practice Address - Fax:702-877-6711
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV9215207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV710984126OtherTAX IDENTIFICATION NUMBER
NVNV9215OtherSTATE
NV002018374Medicaid
NVNV9215OtherSTATE
NV100049Medicare ID - Type Unspecified