Provider Demographics
NPI:1295039923
Name:CASSERLY, LESLIE MATTHEWS (RN)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:MATTHEWS
Last Name:CASSERLY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 N SYCAMORE ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701-4607
Mailing Address - Country:US
Mailing Address - Phone:714-836-5447
Mailing Address - Fax:714-836-1855
Practice Address - Street 1:415 N SYCAMORE ST
Practice Address - Street 2:SUITE 200
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-4607
Practice Address - Country:US
Practice Address - Phone:714-836-5447
Practice Address - Fax:714-836-1855
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-10
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA306621261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health