Healthcare Provider Details

I. General information

NPI: 1083654677
Provider Name (Legal Business Name): LESLIE G MENCHETTI APRN, BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 06/05/2020
Certification Date: 06/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 CORTINA DR
ORLAND CA
95963-1699
US

IV. Provider business mailing address

1211 CORTINA DR
ORLAND CA
95963-1699
US

V. Phone/Fax

Practice location:
  • Phone: 530-865-5544
  • Fax: 530-865-9209
Mailing address:
  • Phone: 530-865-5544
  • Fax: 530-865-9209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number080771
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number13-43718-072
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number22577
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: