Provider Demographics
NPI:1972677409
Name:GROVAS, LESA JEANENE (NP)
Entity Type:Individual
Prefix:MS
First Name:LESA
Middle Name:JEANENE
Last Name:GROVAS
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:CHOC CHILDREN'S HOSPITAL OF ORANGE
Mailing Address - Street 2:1201 W. LE VETA AVENUE
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868
Mailing Address - Country:US
Mailing Address - Phone:714-509-9331
Mailing Address - Fax:
Practice Address - Street 1:CHOC CHILDREN'S HOSPITAL OF ORANGE
Practice Address - Street 2:1201 W. LE VETA AVENUE
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868
Practice Address - Country:US
Practice Address - Phone:714-509-9331
Practice Address - Fax:402-955-7405
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE110266363LP0200X
CA95010725363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1578179Medicaid
NE37925OtherBCBS
218343OtherCOVENTRY