Provider Demographics
NPI:1750329959
Name:REMEDI, LESLIE M (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:M
Last Name:REMEDI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 15645
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89114-5645
Mailing Address - Country:US
Mailing Address - Phone:702-579-3270
Mailing Address - Fax:702-459-0331
Practice Address - Street 1:540 N NELLIS BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89110-5368
Practice Address - Country:US
Practice Address - Phone:702-459-7424
Practice Address - Fax:702-459-0331
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA871363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1005004981Medicaid
NVV109701OtherSMA MEDICARE
NV1750329959OtherSMA MEDICAID
NV1005004981Medicaid
NV1750329959OtherSMA MEDICAID