Provider Demographics
NPI:1457662611
Name:DR. JOAN S. LEAKS, PC
Entity Type:Organization
Organization Name:DR. JOAN S. LEAKS, PC
Other - Org Name:SOUTHWEST WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:LEAKS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:775-751-2100
Mailing Address - Street 1:2080 E CALVADA BLVD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:PAHRUMP
Mailing Address - State:NV
Mailing Address - Zip Code:89048-6576
Mailing Address - Country:US
Mailing Address - Phone:775-751-2100
Mailing Address - Fax:775-751-2111
Practice Address - Street 1:2080 E CALVADA BLVD
Practice Address - Street 2:SUITE 500
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89048-6576
Practice Address - Country:US
Practice Address - Phone:775-751-2100
Practice Address - Fax:775-751-2111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-23
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5178207QB0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QB0002XAllopathic & Osteopathic PhysiciansFamily MedicineObesity MedicineGroup - Single Specialty