Provider Demographics
NPI:1861027450
Name:VELASQUEZ-LEON, ALICE G (APRN-C)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:G
Last Name:VELASQUEZ-LEON
Suffix:
Gender:F
Credentials:APRN-C
Other - Prefix:
Other - First Name:
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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 1:3131 LA CANADA ST STE 200
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-2579
Practice Address - Country:US
Practice Address - Phone:702-369-5582
Practice Address - Fax:702-650-5148
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-04
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV829434363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1861027450Medicaid
NV829434OtherSTATE LICENSE