Healthcare Provider Details

I. General information

NPI: 1144585837
Provider Name (Legal Business Name): JONATHAN MICHAEL LEPP PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2012
Last Update Date: 07/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1194 N HOPE AVE
REEDLEY CA
93654-2081
US

IV. Provider business mailing address

47 SANTA ROSA ST
SAN LUIS OBISPO CA
93405-5816
US

V. Phone/Fax

Practice location:
  • Phone: 559-859-5147
  • Fax:
Mailing address:
  • Phone: 805-542-9596
  • Fax: 805-542-9354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA22365
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: