Provider Demographics
NPI:1316176712
Name:FIELD, LESLEY M (PA-C)
Entity type:Individual
Prefix:
First Name:LESLEY
Middle Name:M
Last Name:FIELD
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:4727 DEVONSHIRE PL
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-7407
Mailing Address - Country:US
Mailing Address - Phone:714-571-5000
Mailing Address - Fax:714-571-5055
Practice Address - Street 1:121 SOTOYOME ST
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-4823
Practice Address - Country:US
Practice Address - Phone:707-546-4062
Practice Address - Fax:707-525-4095
Is Sole Proprietor?:No
Enumeration Date:2009-07-07
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA53452363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA144282-00OtherNCBTMB
CA71057OtherAMTA