Provider Demographics
NPI:1730184276
Name:FARBER, LESLIE (MD)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:FARBER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7575 W WASHINGTON AVE STE 127
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-4336
Mailing Address - Country:US
Mailing Address - Phone:702-525-7686
Mailing Address - Fax:
Practice Address - Street 1:7575 W WASHINGTON AVE
Practice Address - Street 2:STE 127
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128
Practice Address - Country:US
Practice Address - Phone:310-402-7484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-20
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA38649207P00000X, 207Q00000X
NY148170207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA28680Medicare UPIN