Provider Demographics
NPI:1134180839
Name:GAN-LIM, LEONARDO ALDECOA (MD)
Entity type:Individual
Prefix:DR
First Name:LEONARDO
Middle Name:ALDECOA
Last Name:GAN-LIM
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 1:2654 TOPAZ BLUE ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-5490
Mailing Address - Country:US
Mailing Address - Phone:702-461-2707
Mailing Address - Fax:
Practice Address - Street 1:653 N TOWN CENTER DR STE 101
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89144-0515
Practice Address - Country:US
Practice Address - Phone:702-805-2435
Practice Address - Fax:702-485-2812
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10945207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV72607OtherMEDICARE