Provider Demographics
NPI:1386641389
Name:SOOHOO, LEO (MA)
Entity Type:Individual
Prefix:MR
First Name:LEO
Middle Name:
Last Name:SOOHOO
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9244 EVERGREEN CANYON DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89134-6059
Mailing Address - Country:US
Mailing Address - Phone:702-369-9706
Mailing Address - Fax:
Practice Address - Street 1:4760 S PECOS RD
Practice Address - Street 2:#103-27
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-5828
Practice Address - Country:US
Practice Address - Phone:702-369-9706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVA-113231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV36711Medicare ID - Type Unspecified