Healthcare Provider Details

I. General information

NPI: 1891726972
Provider Name (Legal Business Name): HEATHER LINNEA LESIEUR PA-C, MS, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 03/31/2020
Certification Date: 03/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5439 CLAYTON RD STE B
CLAYTON CA
94517-1076
US

IV. Provider business mailing address

5439 CLAYTON RD STE B
CLAYTON CA
94517-1076
US

V. Phone/Fax

Practice location:
  • Phone: 925-672-6744
  • Fax: 925-672-3259
Mailing address:
  • Phone: 925-672-6744
  • Fax: 925-672-3259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA23118
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number376879-1206
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: