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NPI Code Detail

MEDICARE: LESLIE OLDHAM NP

MEDICARE: LESLIE OLDHAM NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner95003181CA

General Provider Information

NPI Number : 1164880506
Entity Type Code : Individual
Provider Name (Legal Business Name) : LESLIE OLDHAM NP
Provider Business Mailing Address
First Line : 1127 WILSHIRE BLVD STE 1400
Second Line :
City : LOS ANGELES
State : CA
Zip : 90017-4005
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1127 WILSHIRE BLVD STE 1400
Second Line :
City : LOS ANGELES
State : CA
Zip : 90017-4005
Country : US
Telephone Number : 213-975-9990
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/31/2016
Last Update Date : 01/31/2016

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