Provider Demographics
NPI:1720573009
Name:ANDERSON, LESLIE (MD MED)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MD MED
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:
Other - Last Name:WOLOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8778 SPECTRUM CENTER BLVD APT B202
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-5023
Mailing Address - Country:US
Mailing Address - Phone:858-285-5967
Mailing Address - Fax:
Practice Address - Street 1:5570 OVERLAND AVE STE 101
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1215
Practice Address - Country:US
Practice Address - Phone:858-206-9428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-28
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA156533207ZF0201X
CAPENDING207ZF0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZF0201XAllopathic & Osteopathic PhysiciansPathologyForensic Pathology