Provider Demographics
NPI:1508163593
Name:WHITNEY, LESLIE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:
Last Name:WHITNEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 53366
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92619-3366
Mailing Address - Country:US
Mailing Address - Phone:949-612-9090
Mailing Address - Fax:949-612-9091
Practice Address - Street 1:113 WATERWORKS WAY STE 155
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3163
Practice Address - Country:US
Practice Address - Phone:949-612-9090
Practice Address - Fax:949-612-9091
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-28
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17159363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant