Provider Demographics
NPI:1033152616
Name:TUCHMAN, LESLIE J (MD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:J
Last Name:TUCHMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LESLIE
Other - Middle Name:J
Other - Last Name:GOLDBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1934 CREST DR
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-5268
Mailing Address - Country:US
Mailing Address - Phone:646-522-6246
Mailing Address - Fax:718-374-6092
Practice Address - Street 1:16745 W BERNARDO DR STE 240
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92127-1908
Practice Address - Country:US
Practice Address - Phone:442-248-0636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY229314207R00000X
CA148437207RH0002X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0244131Medicaid
NY97S031Medicare PIN