Provider Demographics
NPI:1366509499
Name:PAUL, LESLIE DIANA (MD)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:DIANA
Last Name:PAUL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3831 HUGHES AVE
Mailing Address - Street 2:SUITE 705
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232-2751
Mailing Address - Country:US
Mailing Address - Phone:310-558-8600
Mailing Address - Fax:310-558-8650
Practice Address - Street 1:3831 HUGHES AVE
Practice Address - Street 2:SUITE 705
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232-2751
Practice Address - Country:US
Practice Address - Phone:310-558-8600
Practice Address - Fax:310-558-8650
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG61506207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOG615060Medicaid
CAG61506OtherLICENSE NUMBER
CAG61506OtherLICENSE NUMBER
CAG61506Medicare ID - Type UnspecifiedPROVIDER NUMBER