Individual provider Active NPI

Lesley Ann Laird, PA-C

  • Medical Physician Assistant
  • Riverside, CA
National Provider Identifier
1144313420
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA18146 Issued in CA
Practice address
4646 Brockton Ave
Riverside, CA 92506-0102
Phone
(951) 774-2723
Fax
(951) 231-1361
NPI assigned
Oct 1, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA18146 CA Primary

Addresses

Primary practice location

4646 Brockton Ave
Riverside, CA 92506-0102

Mailing address

4646 Brockton Ave
Riverside, CA 92506-0102
Phone (951) 774-2723

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161026001598 CA Practitioner - Physician Assistant 2163727728 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1295 Hamner Ave
Suite C
Norco, CA 92860-3161
Phone (951) 272-6500

18876 Van Buren Blvd
Suite 101
Riverside, CA 92508-9114
Phone (951) 429-6003

2101 N Waterman Ave
San Bernardino, CA 92404-4836
Phone (909) 596-6349

33494 Oak Glen Rd
Yucaipa, CA 92399-2057
Phone (909) 797-8900

3480 La Sierra Ave
Suite B
Riverside, CA 92503-5204
Phone (951) 588-8901

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA18146CAMDMedical Physician Assistant
18146CAMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Southern California Emergency Medicine CurrentSince Sep 6, 2016 Accepting new patients
Southern California Emergency Medicine CurrentSince Sep 6, 2016 Accepting new patients

Locations

1407 Foothill Blvd
La Verne, CA 91750
Phone (909) 596-3577

1295 Hamner Ave
Ste C
Norco, CA 92860
Phone (951) 272-6500

33494 Oak Glen Rd
Yucaipa, CA 92399
Phone (909) 797-8900

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159660800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1144313420",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4646 BROCKTON AVE",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925060102",
            "telephone_number": "951-774-2723",
            "fax_number": "951-231-1361"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4646 BROCKTON AVE",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925060102",
            "telephone_number": "951-774-2723",
            "fax_number": "951-231-1361"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAIRD",
        "first_name": "LESLEY",
        "middle_name": "ANN",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "PA18146",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverside, CA

Sources for this page

Verify at the official NPI Registry.