Provider Demographics
NPI:1063483097
Name:CAPOBIANCO, LEO JOSEPH (DO)
Entity Type:Individual
Prefix:DR
First Name:LEO
Middle Name:JOSEPH
Last Name:CAPOBIANCO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2801 N TENAYA WAY STE C
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-1400
Mailing Address - Country:US
Mailing Address - Phone:702-684-7800
Mailing Address - Fax:702-684-7878
Practice Address - Street 1:2801 N TENAYA WAY STE C
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-1400
Practice Address - Country:US
Practice Address - Phone:702-684-7800
Practice Address - Fax:702-684-7878
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-28
Last Update Date:2023-07-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NV958207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F43748Medicare UPIN