Provider Demographics
NPI:1376912410
Name:VERA LEON, MARIA D (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:D
Last Name:VERA LEON
Suffix:
Gender:F
Credentials:PA-C
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Other - Credentials:
Mailing Address - Street 1:2370 CORPORATE CIR STE 300
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-7760
Mailing Address - Country:US
Mailing Address - Phone:702-910-3950
Mailing Address - Fax:702-778-2264
Practice Address - Street 1:2831 BUSINESS PARK CT STE 130
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-9000
Practice Address - Country:US
Practice Address - Phone:702-844-4848
Practice Address - Fax:702-844-4849
Is Sole Proprietor?:No
Enumeration Date:2015-09-18
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NVPA1657363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1376912410Medicaid
NVPENDINGMedicare PIN