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General NPI Number Information
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NPI Number | 1831713833
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Entity Type | Individual
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Provider Name | DIEGO LESCANO PA
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Gender | Male
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Dates
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Enumeration Date | 06/04/2020
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Last Update Date | 07/24/2022
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Provider Practice Location Address
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Address Line | 1420 N TRACY BLVD
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City | TRACY
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State | CA
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Zip | 95376-3451
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Country | US
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Telephone | 209-832-6018
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Fax |
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Provider Business Mailing Address
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Address Line | 427 ALVARADO ST
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City | BRISBANE
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State | CA
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Zip | 94005-1603
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Country | US
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Telephone | 415-756-2548
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 58606
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License Number State | CA
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