Provider Demographics
NPI:1568984664
Name:LESLIE, ANDIE MAIKA (MS)
Entity Type:Individual
Prefix:
First Name:ANDIE
Middle Name:MAIKA
Last Name:LESLIE
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 S BASCOM AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-3536
Mailing Address - Country:US
Mailing Address - Phone:650-448-9194
Mailing Address - Fax:
Practice Address - Street 1:950 S BASCOM AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-3536
Practice Address - Country:US
Practice Address - Phone:650-448-9194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-10
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program