1508574658 NPI number — MRS. LESLIE TAYLAN BARAHONA FNP- BC

Table of content: MRS. LESLIE TAYLAN BARAHONA FNP- BC (NPI 1508574658)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508574658 NPI number — MRS. LESLIE TAYLAN BARAHONA FNP- BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARAHONA
Provider First Name:
LESLIE
Provider Middle Name:
TAYLAN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP- BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508574658
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/08/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1625 KENSINGTON PARK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MODESTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95356-9363
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-386-8947
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1700 CALIFORNIA ST STE 570
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN FRANCISCO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94109-4591
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-673-9199
Provider Business Practice Location Address Fax Number:
415-673-8796
Provider Enumeration Date:
11/08/2022

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: 363LF0000X , with the licence number:  95023276 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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