Provider Demographics
NPI:1003547449
Name:SALVATIERRA, LESLEY DANIELLE (CSFA)
Entity Type:Individual
Prefix:
First Name:LESLEY
Middle Name:DANIELLE
Last Name:SALVATIERRA
Suffix:
Gender:F
Credentials:CSFA
Other - Prefix:
Other - First Name:LESLEY
Other - Middle Name:DANIELLE
Other - Last Name:SIEGEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:526 OAK DR
Mailing Address - Street 2:
Mailing Address - City:HAPEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30354-1117
Mailing Address - Country:US
Mailing Address - Phone:954-995-2657
Mailing Address - Fax:
Practice Address - Street 1:6325 HOSPITAL PKWY
Practice Address - Street 2:
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097-5775
Practice Address - Country:US
Practice Address - Phone:678-474-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-17
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA210886246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant