Provider Demographics
NPI:1467701268
Name:DE FRISCO, LESLEAH L
Entity Type:Individual
Prefix:
First Name:LESLEAH
Middle Name:L
Last Name:DE FRISCO
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 1:445 WAWONA ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94116-3058
Mailing Address - Country:US
Mailing Address - Phone:415-681-5500
Mailing Address - Fax:415-379-2227
Practice Address - Street 1:445 WAWONA ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94116-3058
Practice Address - Country:US
Practice Address - Phone:415-681-5500
Practice Address - Fax:415-379-2227
Is Sole Proprietor?:No
Enumeration Date:2012-09-07
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374T00000XNursing Service Related ProvidersReligious Nonmedical Nursing Personnel
No376G00000XNursing Service Related ProvidersNursing Home Administrator