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NPI Code Detail

MEDICARE: LESLIE KARIN HARFORD PA-C

MEDICARE: LESLIE KARIN HARFORD PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantPA15746CA

General Provider Information

NPI Number : 1114164027
Entity Type Code : Individual
Provider Name (Legal Business Name) : LESLIE KARIN HARFORD PA-C
Provider Business Mailing Address
First Line : 2225 CHALLENGER WAY
Second Line :
City : SANTA ROSA
State : CA
Zip : 95407-5441
Country : US
Telephone Number : 707-565-4970
Fax Number : 707-565-5183
Provider Business Practice Location Address
First Line : 2225 CHALLENGER WAY
Second Line :
City : SANTA ROSA
State : CA
Zip : 95407-5441
Country : US
Telephone Number : 707-565-4970
Fax Number : 707-565-5183
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/14/2009
Last Update Date : 05/15/2019

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