Provider Demographics
NPI:1619049426
Name:OLIVERA, LEILA R (MD)
Entity Type:Individual
Prefix:
First Name:LEILA
Middle Name:R
Last Name:OLIVERA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LEILA
Other - Middle Name:N
Other - Last Name:RAYMUNDO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6355 S BUFFALO DR FL 3
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-2133
Mailing Address - Country:US
Mailing Address - Phone:702-216-3346
Mailing Address - Fax:702-671-6883
Practice Address - Street 1:1297 BOULDER CITY PKWY STE A
Practice Address - Street 2:
Practice Address - City:BOULDER CITY
Practice Address - State:NV
Practice Address - Zip Code:89005-1854
Practice Address - Country:US
Practice Address - Phone:702-294-1919
Practice Address - Fax:702-294-0072
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA46610207R00000X
NV17857207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1619049426Medicaid
NV17857OtherSTATE LICENSE