Provider Demographics
NPI:1386663409
Name:DE MONTRICHARD, LESLIE ANN (MD)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:ANN
Last Name:DE MONTRICHARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:ANN
Other - Last Name:DE MONTRICHARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3210 PASEO VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:SAN MARTIN
Mailing Address - State:CA
Mailing Address - Zip Code:95046-9795
Mailing Address - Country:US
Mailing Address - Phone:408-776-9888
Mailing Address - Fax:
Practice Address - Street 1:90 HIGHLAND AVE
Practice Address - Street 2:VHC SAN MARTIN FAMILY PRACTICE CLINIC
Practice Address - City:SAN MARTIN
Practice Address - State:CA
Practice Address - Zip Code:95046-9504
Practice Address - Country:US
Practice Address - Phone:408-686-2217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA50366207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A503660Medicaid
CA00A503660Medicaid
CA00A503661Medicare ID - Type Unspecified