Provider Demographics
NPI:1437600350
Name:MORI, LESLEY NOEL (PA-C)
Entity Type:Individual
Prefix:
First Name:LESLEY
Middle Name:NOEL
Last Name:MORI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LESLEY
Other - Middle Name:NOEL
Other - Last Name:ANGLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:950 TALL TREES DR
Mailing Address - Street 2:
Mailing Address - City:NIPOMO
Mailing Address - State:CA
Mailing Address - Zip Code:93444-5708
Mailing Address - Country:US
Mailing Address - Phone:512-922-5545
Mailing Address - Fax:805-737-8702
Practice Address - Street 1:1225 N H ST
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-3301
Practice Address - Country:US
Practice Address - Phone:805-737-8700
Practice Address - Fax:057-378-7028
Is Sole Proprietor?:No
Enumeration Date:2016-10-14
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53909363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical