Healthcare Provider Details

I. General information

NPI: 1508574658
Provider Name (Legal Business Name): LESLIE TAYLAN BARAHONA FNP- BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2022
Last Update Date: 11/08/2022
Certification Date: 11/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 CALIFORNIA ST STE 570
SAN FRANCISCO CA
94109-4591
US

IV. Provider business mailing address

1625 KENSINGTON PARK DR
MODESTO CA
95356-9363
US

V. Phone/Fax

Practice location:
  • Phone: 415-673-9199
  • Fax: 415-673-8796
Mailing address:
  • Phone: 808-386-8947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95023276
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: