Healthcare Provider Details

I. General information

NPI: 1851108120
Provider Name (Legal Business Name): LESLIE LOPEZ SANCHEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2024
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1390 W 16TH ST
YUMA AZ
85364-4430
US

IV. Provider business mailing address

2400 S AVENUE A
YUMA AZ
85364-7170
US

V. Phone/Fax

Practice location:
  • Phone: 928-344-4325
  • Fax: 928-344-3084
Mailing address:
  • Phone: 928-344-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number11339
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: