Provider Demographics
NPI:1477044725
Name:SOLARES, LESLIE (BCBA)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:SOLARES
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 S OXFORD AVE APT 16
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-5112
Mailing Address - Country:US
Mailing Address - Phone:213-369-3063
Mailing Address - Fax:
Practice Address - Street 1:5777 W CENTURY BLVD STE 675
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-5632
Practice Address - Country:US
Practice Address - Phone:310-649-0499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-22
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst