Provider Demographics
NPI:1790335131
Name:GADOR-MARCELINO, LEILANI PAZ
Entity Type:Individual
Prefix:
First Name:LEILANI
Middle Name:PAZ
Last Name:GADOR-MARCELINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LEILANI
Other - Middle Name:PAZ
Other - Last Name:GADOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6588 BAROQUE AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89139-6738
Mailing Address - Country:US
Mailing Address - Phone:702-339-8872
Mailing Address - Fax:
Practice Address - Street 1:715 MALL RING CIR STE 202
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-6667
Practice Address - Country:US
Practice Address - Phone:702-768-1078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-18
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV819631363LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine