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General NPI Number Information
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NPI Number | 1144395799
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Entity Type | Individual
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Provider Name | LESLIE ANNETTE DAVIS PA
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Gender | Female
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Dates
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Enumeration Date | 11/21/2006
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Last Update Date | 08/23/2022
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Provider Practice Location Address
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Address Line | 3751 KATELLA AVE
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City | LOS ALAMITOS
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State | CA
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Zip | 90720-3113
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Country | US
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Telephone | 562-246-6822
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Fax | 562-330-2402
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Provider Business Mailing Address
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Address Line | 11947 VALLEY VIEW ST UNIT 5671
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City | GARDEN GROVE
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State | CA
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Zip | 92846-6523
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Country | US
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Telephone | 562-246-6822
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Fax | 562-330-2402
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 16993
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License Number State | CA
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