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General NPI Number Information
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NPI Number | 1396654281
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Entity Type | Individual
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Provider Name | LESLIE EMWINMA EVBUOMWAN
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Gender | Male
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Dates
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Enumeration Date | 09/04/2026
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Last Update Date | 09/04/2026
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Provider Practice Location Address
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Address Line | 1642 W AVENUE J
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City | LANCASTER
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State | CA
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Zip | 93534-2814
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Country | US
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Telephone | 203-768-7549
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Fax |
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Provider Business Mailing Address
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Address Line | 40932 OAKVIEW LN
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City | PALMDALE
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State | CA
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Zip | 93551-2775
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Country | US
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Telephone | 203-768-7549
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 95034380
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95034380
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License Number State | CA
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