Provider Demographics
NPI:1699886366
Name:DO PICO, LESLIE E (CRNA)
Entity type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:E
Last Name:DO PICO
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 913001
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80291-3001
Mailing Address - Country:US
Mailing Address - Phone:817-334-0530
Mailing Address - Fax:817-877-0350
Practice Address - Street 1:320 BEARD CREEK ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:EDWARDS
Practice Address - State:CO
Practice Address - Zip Code:81632-6426
Practice Address - Country:US
Practice Address - Phone:970-569-7400
Practice Address - Fax:817-877-0350
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9170464367500000X
COAPN.0993819-CRNA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL306848000Medicaid
FL306848000Medicaid