Healthcare Provider Details

I. General information

NPI: 1720337587
Provider Name (Legal Business Name): LEILA R JIRARI PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2012
Last Update Date: 10/20/2020
Certification Date: 10/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10121 PINE AVE
TRUCKEE CA
96161-4835
US

IV. Provider business mailing address

10121 PINE AVE
TRUCKEE CA
96161-4835
US

V. Phone/Fax

Practice location:
  • Phone: 530-582-1212
  • Fax:
Mailing address:
  • Phone: 530-587-6011
  • Fax: 805-683-3400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA22352
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: