Healthcare Provider Details

I. General information

NPI: 1245355437
Provider Name (Legal Business Name): LESLIE ANN RICE N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 PARK BOULEVARD A116
SAN DIEGO CA
92101
US

IV. Provider business mailing address

4060MT.EVEREST BOULEVARD
SAN DIEGO CA
92111
US

V. Phone/Fax

Practice location:
  • Phone: 619-388-3450
  • Fax:
Mailing address:
  • Phone: 858-576-6315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: