MEDICARE: LESLIE ANN SHOWALTER

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	225400000X	Rehabilitation Practitioner

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5077190275789739	OTHER	CA	CALFRESH
2	909258752	OTHER	CA	BLUE SHIELD OF CALIFORNIA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760089122
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE ANN SHOWALTER

Provider Business Mailing Address
First Line	:	6720 TAMPA AVE
Second Line	:
City	:	RESEDA
State	:	CA
Zip	:	91335-5014
Country	:	US
Telephone Number	:	818-781-1073
Fax Number	:

Provider Business Practice Location Address
First Line	:	6720 TAMPA AVE
Second Line	:
City	:	RESEDA
State	:	CA
Zip	:	91335-5014
Country	:	US
Telephone Number	:	818-781-1073
Fax Number	:

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

Provider Enumeration Date	:	10/07/2020
Last Update Date	:	10/07/2020

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Directions to “ LESLIE ANN SHOWALTER ” Practice Location

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