Provider Demographics
NPI:1457356461
Name:DIAZ, LUIS LEON (MD)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:LEON
Last Name:DIAZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2880 N TENAYA WAY STE 405
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0642
Mailing Address - Country:US
Mailing Address - Phone:702-233-0755
Mailing Address - Fax:702-233-8814
Practice Address - Street 1:2880 N TENAYA WAY STE 405
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0642
Practice Address - Country:US
Practice Address - Phone:702-233-0755
Practice Address - Fax:702-233-8814
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2022-07-22
Deactivation Date:2006-03-18
Deactivation Code:
Reactivation Date:2006-03-31
Provider Licenses
StateLicense IDTaxonomies
NVNV61242084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2019070Medicaid
NV2019070Medicaid
NVE79737Medicare UPIN