Provider Demographics
NPI:1497523666
Name:ABAO, LEVI LUKE MANUEL
Entity Type:Individual
Prefix:
First Name:LEVI LUKE
Middle Name:MANUEL
Last Name:ABAO
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 1:9110 W TROPICANA AVE UNIT 287
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-8254
Mailing Address - Country:US
Mailing Address - Phone:925-639-4173
Mailing Address - Fax:
Practice Address - Street 1:6048 S DURANGO DR STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-1781
Practice Address - Country:US
Practice Address - Phone:702-260-6238
Practice Address - Fax:702-263-6530
Is Sole Proprietor?:No
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVOT-3372225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist