MEDICARE: LESLIE RANGEL GONZALEZ FNP

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
1	207R00000X	Internal Medicine Physician	95015138	CA
2	363LF0000X	Family Nurse Practitioner	95015138	CA

General Provider Information

NPI Number	:	1346843653
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE RANGEL GONZALEZ FNP

Provider Business Mailing Address
First Line	:	645 E PALOMAR ST
Second Line	:
City	:	CHULA VISTA
State	:	CA
Zip	:	91911-6974
Country	:	US
Telephone Number	:	619-421-6500
Fax Number	:	619-421-4771

Provider Business Practice Location Address
First Line	:	645 E PALOMAR ST
Second Line	:
City	:	CHULA VISTA
State	:	CA
Zip	:	91911-6974
Country	:	US
Telephone Number	:	619-421-6500
Fax Number	:	619-421-4771

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/19/2020
Last Update Date	:	06/10/2026

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