Provider Demographics
NPI:1497116354
Name:MOZO, LEOPOLDO C
Entity Type:Individual
Prefix:
First Name:LEOPOLDO
Middle Name:C
Last Name:MOZO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2870 S JONES BLVD
Mailing Address - Street 2:115
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-5643
Mailing Address - Country:US
Mailing Address - Phone:786-262-6408
Mailing Address - Fax:
Practice Address - Street 1:7300 LA MONA CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0541
Practice Address - Country:US
Practice Address - Phone:786-262-6408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-18
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV825417363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily