Provider Demographics
NPI:1659551075
Name:LESLIE, DIANE
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:LESLIE
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 1:1848 LINCOLN BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-4580
Mailing Address - Country:US
Mailing Address - Phone:310-396-6556
Mailing Address - Fax:310-396-8437
Practice Address - Street 1:1848 LINCOLN BLVD STE 100
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-4580
Practice Address - Country:US
Practice Address - Phone:310-396-6556
Practice Address - Fax:310-396-8437
Is Sole Proprietor?:No
Enumeration Date:2007-11-14
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator