Provider Demographics
NPI:1649793571
Name:EXCONDE, LESLIE (REGISTERED NURSE)
Entity type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:
Last Name:EXCONDE
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17822 BEACH BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-7510
Mailing Address - Country:US
Mailing Address - Phone:714-982-7048
Mailing Address - Fax:714-845-9941
Practice Address - Street 1:17822 BEACH BLVD STE 400
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-7510
Practice Address - Country:US
Practice Address - Phone:714-982-7048
Practice Address - Fax:714-845-9941
Is Sole Proprietor?:No
Enumeration Date:2017-07-23
Last Update Date:2017-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA757529163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management