Basic Information
| Provider Information | |||||||||
| NPI: | 1215341938 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEAVITT | ||||||||
| FirstName: | TRENT | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2370 CORPORATE CIR STE 300 | ||||||||
| Address2: | |||||||||
| City: | HENDERSON | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890747760 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7029103950 | ||||||||
| FaxNumber: | 7027866650 | ||||||||
| Practice Location | |||||||||
| Address1: | 2831 BUSINESS PARK CT STE 130A | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891289007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7028444848 | ||||||||
| FaxNumber: | 7028444849 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2014 | ||||||||
| LastUpdateDate: | 08/24/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | DO3009 | NV | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 125065536 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208000000X | 125065536 | IL | N | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.