Provider Demographics
NPI:1548439474
Name:MIGDAL, LESLIE A (NP)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:A
Last Name:MIGDAL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10076
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91410-0076
Mailing Address - Country:US
Mailing Address - Phone:805-578-8300
Mailing Address - Fax:805-578-8950
Practice Address - Street 1:5400 BALBOA BLVD
Practice Address - Street 2:SUITE 212
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-1502
Practice Address - Country:US
Practice Address - Phone:818-528-2900
Practice Address - Fax:818-783-3299
Is Sole Proprietor?:No
Enumeration Date:2008-02-25
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA256353363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner