Provider Demographics
NPI:1760256218
Name:GONZALEZ, LESLY
Entity Type:Individual
Prefix:
First Name:LESLY
Middle Name:
Last Name:GONZALEZ
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 1:655 CALLE MCKINLEY APT A
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-3232
Mailing Address - Country:US
Mailing Address - Phone:787-428-4365
Mailing Address - Fax:
Practice Address - Street 1:701 AVE PONCE DE LEON STE 108A
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-3256
Practice Address - Country:US
Practice Address - Phone:787-428-4365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-14
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach