Provider Demographics
NPI:1023142643
Name:HOPPER, LESLIE ANN (DVC)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:ANN
Last Name:HOPPER
Suffix:
Gender:F
Credentials:DVC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3229 FRANCIS AVE
Mailing Address - Street 2:APT. #2
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-6543
Mailing Address - Country:US
Mailing Address - Phone:530-642-9768
Mailing Address - Fax:
Practice Address - Street 1:2914 COLD SPRINGS RD
Practice Address - Street 2:SUITE A
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-4220
Practice Address - Country:US
Practice Address - Phone:530-642-1715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2804174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2804OtherCAS