Healthcare Provider Details

I. General information

NPI: 1316176712
Provider Name (Legal Business Name): LESLEY M FIELD PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2009
Last Update Date: 09/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 SOTOYOME ST
SANTA ROSA CA
95405-4823
US

IV. Provider business mailing address

4727 DEVONSHIRE PL
SANTA ROSA CA
95405-7407
US

V. Phone/Fax

Practice location:
  • Phone: 707-546-4062
  • Fax: 707-525-4095
Mailing address:
  • Phone: 714-571-5000
  • Fax: 714-571-5055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number53452
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: