Provider Demographics
NPI:1073296455
Name:FUNES, LESLIE ORALIA
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:ORALIA
Last Name:FUNES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11150 GLENOAKS BLVD UNIT 243
Mailing Address - Street 2:
Mailing Address - City:PACOIMA
Mailing Address - State:CA
Mailing Address - Zip Code:91331-6663
Mailing Address - Country:US
Mailing Address - Phone:818-414-4632
Mailing Address - Fax:
Practice Address - Street 1:11150 GLENOAKS BLVD UNIT 243
Practice Address - Street 2:
Practice Address - City:PACOIMA
Practice Address - State:CA
Practice Address - Zip Code:91331-6663
Practice Address - Country:US
Practice Address - Phone:818-414-4632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA76882355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant