Provider Demographics
NPI:1508574658
Name:BARAHONA, LESLIE TAYLAN (FNP- BC)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:TAYLAN
Last Name:BARAHONA
Suffix:
Gender:F
Credentials:FNP- BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 KENSINGTON PARK DR
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95356-9363
Mailing Address - Country:US
Mailing Address - Phone:808-386-8947
Mailing Address - Fax:
Practice Address - Street 1:1700 CALIFORNIA ST STE 570
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-4591
Practice Address - Country:US
Practice Address - Phone:415-673-9199
Practice Address - Fax:415-673-8796
Is Sole Proprietor?:No
Enumeration Date:2022-11-08
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95023276363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily