Individual provider Active NPI

Leslie Van La

  • Physician Assistant
  • Los Angeles, CA
National Provider Identifier
1407207905
Registry record updated Jan 10, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA 53552 Issued in CA
Practice address
1441 Eastlake Ave
Suite 7416
Los Angeles, CA 90089-9178
Phone
(323) 865-3700
NPI assigned
Jun 27, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA 53552 CA Primary

Addresses

Primary practice location

1441 Eastlake Ave
Suite 7416
Los Angeles, CA 90089-9178

Mailing address

PO Box 31309
Los Angeles, CA 90031-0309
Phone (323) 865-3700

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, OR2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20170123001913 CA Practitioner - Physician Assistant 1951683192 Reassigns benefits to 1 organization
I20211201001944 OR Practitioner - Physician Assistant 1951683192 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
University of Southern California Keck School of Medicine, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Marquis Clinical Services LLCGroup PAC ID 2860827821, 24 clinicians

Practice addresses (Care Compare)

4560 SE International Way
Suite 100
Milwaukie, OR 97222-4628
Phone (971) 206-5164

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
53552CAMDDentist
PA 53552CAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Usc Care Medical Group, Inc CurrentSince Dec 11, 2016 Accepting new patients
Usc Care Medical Group, Inc CurrentSince Dec 11, 2016 Accepting new patients

Locations

420 34th St
Bakersfield, CA 93301
Phone (661) 324-4647

1441 Eastlake Ave
Ste 7416
Los Angeles, CA 90089
Phone (323) 865-3700

1520 San Pablo St
Los Angeles, CA 90033
Phone (323) 442-5849

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1466985600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1484006400000",
    "number": "1407207905",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 31309",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900310309",
            "telephone_number": "323-865-3700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1441 EASTLAKE AVE",
            "address_2": "SUITE 7416",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900899178",
            "telephone_number": "323-865-3700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LA",
        "first_name": "LESLIE",
        "middle_name": "VAN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-06-27",
        "last_updated": "2017-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA 53552",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.