Provider Demographics
NPI:1831491984
Name:DE LA FLOR, LESLIE ALYSON (FNP-BC)
Entity type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:ALYSON
Last Name:DE LA FLOR
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 1:720 S. RUBY LANE
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-4841
Mailing Address - Country:US
Mailing Address - Phone:714-904-5713
Mailing Address - Fax:714-974-3106
Practice Address - Street 1:1845 W. ORANGEWOOD
Practice Address - Street 2:SUITE 100A
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-2051
Practice Address - Country:US
Practice Address - Phone:714-712-9559
Practice Address - Fax:714-712-9529
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-23
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA247957363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6371026Medicaid
CAP99002Medicare UPIN