Provider Demographics
NPI:1316133754
Name:HIRSCHAUT, LESLIE ANN (MD)
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:ANN
Last Name:HIRSCHAUT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2118
Mailing Address - Street 2:
Mailing Address - City:LOOMIS
Mailing Address - State:CA
Mailing Address - Zip Code:95650
Mailing Address - Country:US
Mailing Address - Phone:916-202-5282
Mailing Address - Fax:916-660-1646
Practice Address - Street 1:2499 HUMPHREY RD
Practice Address - Street 2:
Practice Address - City:LOOMIS
Practice Address - State:CA
Practice Address - Zip Code:95650
Practice Address - Country:US
Practice Address - Phone:916-489-3336
Practice Address - Fax:916-660-1646
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-19
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA0498112084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A498710Medicaid
CA00A498710Medicaid
CA00A498110Medicare PIN