Provider Demographics
NPI:1902953862
Name:VANSCHAACK, LESLIE ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:ANN
Last Name:VANSCHAACK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LESLIE
Other - Middle Name:ANN
Other - Last Name:VAN SCHAACK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:320 DARDANELLI LN STE 16
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-1419
Mailing Address - Country:US
Mailing Address - Phone:408-866-7830
Mailing Address - Fax:
Practice Address - Street 1:320 DARDANELLI LN STE 16
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-1419
Practice Address - Country:US
Practice Address - Phone:408-866-7830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA121754208000000X, 208000000X
VA0101240524208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics