Provider Demographics
NPI:1093259558
Name:ESPE, LESLIE ANN REYES (AGNP-C)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE ANN
Middle Name:REYES
Last Name:ESPE
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 E DOMINGUEZ ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90746-3600
Mailing Address - Country:US
Mailing Address - Phone:310-715-7755
Mailing Address - Fax:
Practice Address - Street 1:1000 E DOMINGUEZ ST
Practice Address - Street 2:SUITE 110
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90746-3600
Practice Address - Country:US
Practice Address - Phone:310-715-7755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-16
Last Update Date:2017-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95003746363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care