MEDICARE: MS. HEATHER LINNEA LESIEUR PA-C, MS, MPH

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	363A00000X	Physician Assistant	PA23118	CA
2	363A00000X	Physician Assistant	376879-1206	UT

General Provider Information

NPI Number	:	1891726972
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. HEATHER LINNEA LESIEUR PA-C, MS, MPH

Provider Business Mailing Address
First Line	:	5439 CLAYTON RD STE B
Second Line	:
City	:	CLAYTON
State	:	CA
Zip	:	94517-1076
Country	:	US
Telephone Number	:	925-672-6744
Fax Number	:	925-672-3259

Provider Business Practice Location Address
First Line	:	5439 CLAYTON RD STE B
Second Line	:
City	:	CLAYTON
State	:	CA
Zip	:	94517-1076
Country	:	US
Telephone Number	:	925-672-6744
Fax Number	:	925-672-3259

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

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	03/31/2020

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