Provider Demographics
NPI:1598992018
Name:LEONG, ROBERTA JEAN (LAC)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:JEAN
Last Name:LEONG
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7575 W WASHINGTON AVE
Mailing Address - Street 2:SUITE 127, #415
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-4333
Mailing Address - Country:US
Mailing Address - Phone:702-799-9979
Mailing Address - Fax:
Practice Address - Street 1:7821 HARPER AVE
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-2213
Practice Address - Country:US
Practice Address - Phone:702-799-9979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-11
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2483171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2483OtherACUPUNCTURE BOARD