Provider Demographics
NPI:1174089908
Name:CEDILLO, LESLIE
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:CEDILLO
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 1:3303 HARBOR BLVD STE B8
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-1517
Mailing Address - Country:US
Mailing Address - Phone:714-786-6069
Mailing Address - Fax:714-834-9822
Practice Address - Street 1:1820 W ORANGEWOOD AVE STE 110
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-5056
Practice Address - Country:US
Practice Address - Phone:714-696-2862
Practice Address - Fax:714-242-9308
Is Sole Proprietor?:No
Enumeration Date:2019-02-17
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106E00000X
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician