Provider Demographics
NPI:1578747424
Name:SMITH, LESLIE MARIE (CMT)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:MARIE
Last Name:SMITH
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2103 SUNDANCE AVE
Mailing Address - Street 2:
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95337-8710
Mailing Address - Country:US
Mailing Address - Phone:209-456-0502
Mailing Address - Fax:
Practice Address - Street 1:965 E YOSEMITE AVE
Practice Address - Street 2:
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95336-5938
Practice Address - Country:US
Practice Address - Phone:209-456-0502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker