Provider Demographics
NPI:1891439147
Name:CALLEJAS, LESLIE (DIETITIAN)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:CALLEJAS
Suffix:
Gender:F
Credentials:DIETITIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3085 E FLAMINGO RD STE A
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-4385
Mailing Address - Country:US
Mailing Address - Phone:702-489-3400
Mailing Address - Fax:
Practice Address - Street 1:3085 E FLAMINGO RD STE A
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-4385
Practice Address - Country:US
Practice Address - Phone:702-489-3400
Practice Address - Fax:702-489-3600
Is Sole Proprietor?:No
Enumeration Date:2022-04-22
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV40211-DI-0133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered