Provider Demographics
NPI:1497126932
Name:DILES, LEE
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:
Last Name:DILES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:593 N MCDOWELL BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-8305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:593 N MCDOWELL BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-8305
Practice Address - Country:US
Practice Address - Phone:707-789-9191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-09
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA 8015237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist