Provider Demographics
NPI:1528096294
Name:HORTON, LESLIE ANN (MD)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:ANN
Last Name:HORTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:30810 PARIS CT
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91362-7188
Mailing Address - Country:US
Mailing Address - Phone:213-219-1102
Mailing Address - Fax:818-879-1882
Practice Address - Street 1:200 HILLMONT AVE
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-1647
Practice Address - Country:US
Practice Address - Phone:805-652-6729
Practice Address - Fax:805-652-5730
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG702962084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G702961Medicaid
CAHG70296Medicare PIN
CAF73244Medicare UPIN