Healthcare Provider Details

I. General information

NPI: 1649426545
Provider Name (Legal Business Name): LESLIE O'DANIEL OLIVAS R.N.,B.S.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LESLIE O'DANIEL FOSTER R.N.,B.S.N.,C.N.M

II. Dates (important events)

Enumeration Date: 08/11/2008
Last Update Date: 08/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4212 N 16TH ST
PHOENIX AZ
85016-5319
US

IV. Provider business mailing address

PO BOX 31001-0698
PASADENA CA
91110-0001
US

V. Phone/Fax

Practice location:
  • Phone: 602-263-1200
  • Fax: 602-263-1631
Mailing address:
  • Phone: 602-263-1200
  • Fax: 602-263-1631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License NumberR49680
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License NumberRN093361
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: