Provider Demographics
NPI:1942688932
Name:DOCTORS CENTER AT REDROCK
Entity Type:Organization
Organization Name:DOCTORS CENTER AT REDROCK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEO
Authorized Official - Middle Name:J
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 1:2801 N TENAYA WAY STE C
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-1400
Practice Address - Country:US
Practice Address - Phone:702-684-7800
Practice Address - Fax:702-684-7878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-11
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV958207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty