Provider Demographics
NPI:1932810942
Name:PASCUAL, LESLIE (PA)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:PASCUAL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14651 W WINDROSE DR
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85379-5681
Mailing Address - Country:US
Mailing Address - Phone:480-371-4971
Mailing Address - Fax:
Practice Address - Street 1:14674 W MOUNTAIN VIEW BLVD STE 200
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-2708
Practice Address - Country:US
Practice Address - Phone:623-544-6860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-09
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10254207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty