Provider Demographics
NPI:1245494731
Name:LEVENTHAL, JACQUELINE JEAN (DO)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:JEAN
Last Name:LEVENTHAL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:
Other - Last Name:BERGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:7200 SMOKE RANCH ROAD
Mailing Address - Street 2:#120
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128
Mailing Address - Country:US
Mailing Address - Phone:702-362-0210
Mailing Address - Fax:702-362-0339
Practice Address - Street 1:7200 SMOKE RANCH RD STE 120
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-1116
Practice Address - Country:US
Practice Address - Phone:702-570-6611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-14
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7189207R00000X
NV1020208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist