Provider Demographics
NPI:1447771209
Name:JUAREZ, LESLIE
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:JUAREZ
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 1:2820 SARATOGA RD
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82604-4600
Mailing Address - Country:US
Mailing Address - Phone:307-258-1827
Mailing Address - Fax:307-237-0632
Practice Address - Street 1:2820 SARATOGA RD
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82604-4600
Practice Address - Country:US
Practice Address - Phone:307-258-1827
Practice Address - Fax:307-237-0632
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-02
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management