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General NPI Number Information
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NPI Number | 1558809095
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Entity Type | Individual
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Provider Name | LESLIE LIM RUDOLPH PA-C
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Gender | Female
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Dates
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Enumeration Date | 02/04/2017
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Last Update Date | 02/04/2017
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Provider Practice Location Address
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Address Line | 1525 SUPERIOR AVE SUITE 214
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City | NEWPORT BEACH
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State | CA
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Zip | 92663-3639
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Country | US
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Telephone | 949-722-7902
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Fax | 949-722-7903
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Provider Business Mailing Address
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Address Line | PO BOX 7469
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92615-7469
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Country | US
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Telephone | 714-962-1586
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Fax | 714-962-1586
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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 | 14530
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 14530
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License Number State | CA
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