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General NPI Number Information
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NPI Number | 1003525585
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Entity Type | Individual
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Provider Name | LESLIE FUNG CNM
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Gender | Female
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Dates
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Enumeration Date | 11/23/2022
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Last Update Date | 12/22/2023
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Provider Practice Location Address
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Address Line | 1513 S GRAND AVE STE 220&250
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City | LOS ANGELES
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State | CA
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Zip | 90015-3070
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Country | US
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Telephone | 415-963-2968
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Fax |
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Provider Business Mailing Address
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Address Line | 1830 41ST AVE
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City | SAN FRANCISCO
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State | CA
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Zip | 94122-4004
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | 236344
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 163WC1500X
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Taxonomy Name | Community Health Registered Nurse
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License Number | 802414
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License Number State | NY
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