Provider Demographics
NPI:1174851760
Name:HAZARD, LESLIE JO (MS NP)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:JO
Last Name:HAZARD
Suffix:
Gender:F
Credentials:MS NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1057 ALBION ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92106-2456
Mailing Address - Country:US
Mailing Address - Phone:619-823-7562
Mailing Address - Fax:
Practice Address - Street 1:5555 GROSSMONT CENTER DR
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3019
Practice Address - Country:US
Practice Address - Phone:619-740-6000
Practice Address - Fax:619-740-4886
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-19
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA18999282N00000X
CANP18999363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health