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General NPI Number Information
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NPI Number | 1730807884
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Entity Type | Individual
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Provider Name | LESLIE JAYNE' SMITH FNP-C
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Gender | Female
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Dates
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Enumeration Date | 08/16/2022
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Last Update Date | 08/16/2022
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Provider Practice Location Address
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Address Line | 2018 W 80TH ST
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City | LOS ANGELES
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State | CA
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Zip | 90047-2610
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Country | US
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Telephone | 323-333-6448
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Fax |
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Provider Business Mailing Address
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Address Line | 2851 W 120TH ST STE E574
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City | HAWTHORNE
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State | CA
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Zip | 90250-3395
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Country | US
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Telephone | 323-333-6448
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 95022160
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License Number State | CA
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