1831491984 NPI number — MS. LESLIE ALYSON DE LA FLOR FNP-BC

Table of content: MS. LESLIE ALYSON DE LA FLOR FNP-BC (NPI 1831491984)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831491984 NPI number — MS. LESLIE ALYSON DE LA FLOR FNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DE LA FLOR
Provider First Name:
LESLIE
Provider Middle Name:
ALYSON
Provider Name Prefix Text:
MS.
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:
1831491984
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/23/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
720 S. RUBY LANE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANAHEIM
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92807-4841
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-904-5713
Provider Business Mailing Address Fax Number:
714-974-3106

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1845 W. ORANGEWOOD
Provider Second Line Business Practice Location Address:
SUITE 100A
Provider Business Practice Location Address City Name:
ORANGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92868-2051
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-712-9559
Provider Business Practice Location Address Fax Number:
714-712-9529
Provider Enumeration Date:
11/23/2010

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:  247957 , 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)

  • Identifier: 6371026 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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