1952482499 NPI number — JANA LAMEZ LESLIE LMP

Table of content: JANA LAMEZ LESLIE LMP (NPI 1952482499)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952482499 NPI number — JANA LAMEZ LESLIE LMP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LESLIE
Provider First Name:
JANA
Provider Middle Name:
LAMEZ
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DOUGLAS
Provider Other First Name:
JANA
Provider Other Middle Name:
LAMEZ
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1952482499
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2403 W LYNN STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98199
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-605-1683
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3320 WEST MCGRAW ST
Provider Second Line Business Practice Location Address:
UNRAVEL THERAPUTICS
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98199
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-283-9910
Provider Business Practice Location Address Fax Number:
206-283-9935
Provider Enumeration Date:
10/18/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225700000X , with the licence number:  MA00011771 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)