Provider Demographics
NPI:1073633103
Name:ALHADEFF, LESLIE HACO (MD, MPH)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:HACO
Last Name:ALHADEFF
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41865 BOARDWALK
Mailing Address - Street 2:SUITE 204
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-9026
Mailing Address - Country:US
Mailing Address - Phone:760-674-0331
Mailing Address - Fax:760-674-0332
Practice Address - Street 1:41865 BOARDWALK
Practice Address - Street 2:SUITE 204
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-9026
Practice Address - Country:US
Practice Address - Phone:760-674-0331
Practice Address - Fax:760-674-0332
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG53660103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist