Provider Demographics
NPI:1578317947
Name:ALCAZAR, LESLIE JOY BLANCO
Entity Type:Individual
Prefix:MRS
First Name:LESLIE JOY
Middle Name:BLANCO
Last Name:ALCAZAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16032 LAHEY ST
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-3827
Mailing Address - Country:US
Mailing Address - Phone:818-631-9372
Mailing Address - Fax:
Practice Address - Street 1:16032 LAHEY ST
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-3827
Practice Address - Country:US
Practice Address - Phone:818-631-9372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-12
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95029090363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily