Healthcare Provider Details

I. General information

NPI: 1508440736
Provider Name (Legal Business Name): KARISSA LYNN LECLAIR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2021
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 FREEDOM BLVD
WATSONVILLE CA
95076-2780
US

IV. Provider business mailing address

1430 FREEDOM BLVD
WATSONVILLE CA
95076-2780
US

V. Phone/Fax

Practice location:
  • Phone: 831-763-8400
  • Fax:
Mailing address:
  • Phone: 831-763-8400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA192494
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: