Provider Demographics
NPI:1881205839
Name:GEBA, LEILANY (BUSINESS CONSULTANT)
Entity Type:Individual
Prefix:
First Name:LEILANY
Middle Name:
Last Name:GEBA
Suffix:
Gender:F
Credentials:BUSINESS CONSULTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8845 FIRST LADY AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-3894
Mailing Address - Country:US
Mailing Address - Phone:702-488-4918
Mailing Address - Fax:
Practice Address - Street 1:8845 FIRST LADY AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-3894
Practice Address - Country:US
Practice Address - Phone:702-488-4918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty
No171W00000XOther Service ProvidersContractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV06041981Medicaid