Healthcare Provider Details

I. General information

NPI: 1144403981
Provider Name (Legal Business Name): CHRISTINE M. LESACA P.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2007
Last Update Date: 10/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 ZONAL AVE OPD 3P-61
LOS ANGELES CA
90089-0121
US

IV. Provider business mailing address

2010 ZONAL AVE OPD 3P-61
LOS ANGELES CA
90089-0121
US

V. Phone/Fax

Practice location:
  • Phone: 323-226-5086
  • Fax: 323-226-5134
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number15163
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number544362
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: