Provider Demographics
NPI:1083310890
Name:WILSON, LESLIE MARGARITA
Entity Type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:MARGARITA
Last Name:WILSON
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 1:3208 PORTSMOUTH DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-5325
Mailing Address - Country:US
Mailing Address - Phone:916-533-1629
Mailing Address - Fax:
Practice Address - Street 1:3208 PORTSMOUTH DR
Practice Address - Street 2:
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95670-5325
Practice Address - Country:US
Practice Address - Phone:916-533-1629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-02
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker