Basic Information
| Provider Information | |||||||||
| NPI: | 1083654677 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MENCHETTI | ||||||||
| FirstName: | LESLIE | ||||||||
| MiddleName: | G | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | APRN, BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1211 CORTINA DR | ||||||||
| Address2: | |||||||||
| City: | ORLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959631699 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5308655544 | ||||||||
| FaxNumber: | 5308659209 | ||||||||
| Practice Location | |||||||||
| Address1: | 1211 CORTINA DR | ||||||||
| Address2: | |||||||||
| City: | ORLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959631699 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5308655544 | ||||||||
| FaxNumber: | 5308659209 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2006 | ||||||||
| LastUpdateDate: | 06/05/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 080771 | MO | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 363LF0000X | 13-43718-072 | KS | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | 22577 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 22577 | 01 | CA | CA NP LICENSE | OTHER |