Basic Information
| Provider Information | |||||||||
| NPI: | 1174851760 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAZARD | ||||||||
| FirstName: | LESLIE | ||||||||
| MiddleName: | JO | ||||||||
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| Credential: | MS. NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1057 ALBION ST | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921062456 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6198237562 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5555 GROSSMONT CENTER DR | ||||||||
| Address2: | |||||||||
| City: | LA MESA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919423019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6197406000 | ||||||||
| FaxNumber: | 6197404886 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/19/2009 | ||||||||
| LastUpdateDate: | 03/13/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 18999 | CA | Y | Hospitals | General Acute Care Hospital | 363LA2200X | NP18999 | CA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.