Provider Demographics
NPI:1255685194
Name:HOFMEISTER, LESLIE NICOLE (MS)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:NICOLE
Last Name:HOFMEISTER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18302 IRVINE BLVD
Mailing Address - Street 2:300
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3435
Mailing Address - Country:US
Mailing Address - Phone:714-881-8613
Mailing Address - Fax:
Practice Address - Street 1:18302 IRVINE BLVD
Practice Address - Street 2:300
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3435
Practice Address - Country:US
Practice Address - Phone:714-881-8613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-30
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist