Provider Demographics
NPI:1841658697
Name:LESO, ELAINE ELIZABETH (LVN)
Entity type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:ELIZABETH
Last Name:LESO
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17165 W BERNARDO DR
Mailing Address - Street 2:207
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-1533
Mailing Address - Country:US
Mailing Address - Phone:951-313-3194
Mailing Address - Fax:
Practice Address - Street 1:17165 W BERNARDO DR
Practice Address - Street 2:207
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92127-1533
Practice Address - Country:US
Practice Address - Phone:951-313-3194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-09
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA265756164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse