Provider Demographics
NPI:1689995714
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:702-325-8713
Mailing Address - Street 1:9484 W FLAMINGO RD
Mailing Address - Street 2:SUITE 280
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-5744
Mailing Address - Country:US
Mailing Address - Phone:702-325-8713
Mailing Address - Fax:702-364-8414
Practice Address - Street 1:7272 PALMYRA AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-3112
Practice Address - Country:US
Practice Address - Phone:702-325-8713
Practice Address - Fax:702-364-8414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-11
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5178207QB0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QB0002XAllopathic & Osteopathic PhysiciansFamily MedicineObesity MedicineGroup - Single Specialty