Provider Demographics
NPI:1700995446
Name:RUIZ-LEON, LILIANA (DO)
Entity type:Individual
Prefix:
First Name:LILIANA
Middle Name:
Last Name:RUIZ-LEON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2159 STAGE STOP DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-5824
Mailing Address - Country:US
Mailing Address - Phone:702-588-3613
Mailing Address - Fax:
Practice Address - Street 1:2020 WELLNESS WAY STE 206
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4145
Practice Address - Country:US
Practice Address - Phone:702-893-8968
Practice Address - Fax:702-458-2478
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1263207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100509794Medicaid