Provider Demographics
NPI:1346051778
Name:JABAL, LESLIE ANN VALLEJO (ACNPC)
Entity type:Individual
Prefix:
First Name:LESLIE ANN
Middle Name:VALLEJO
Last Name:JABAL
Suffix:
Gender:
Credentials:ACNPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4155 S BOWERY PL
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-3913
Mailing Address - Country:US
Mailing Address - Phone:626-475-5880
Mailing Address - Fax:
Practice Address - Street 1:4155 S BOWERY PL
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91761-3913
Practice Address - Country:US
Practice Address - Phone:626-475-5880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-15
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95033570363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner