Provider Demographics
NPI:1891163770
Name:LEO J. CAPOBIANCO, D.O., LTD.
Entity Type:Organization
Organization Name:LEO J. CAPOBIANCO, D.O., LTD.
Other - Org Name:DOCTORS CENTER SOUTHWEST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LEO
Authorized Official - Middle Name:
Authorized Official - Last Name:CAPOBIANCO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:702-684-7800
Mailing Address - Street 1:2801 N TENAYA WAY STE C
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-1400
Mailing Address - Country:US
Mailing Address - Phone:702-684-7800
Mailing Address - Fax:702-684-7878
Practice Address - Street 1:6120 S FORT APACHE RD STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-6760
Practice Address - Country:US
Practice Address - Phone:702-602-5444
Practice Address - Fax:702-602-5454
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LEO J. CAPOBIANCO, D.O. LTD.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-09-09
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty