Provider Demographics
NPI:1821732710
Name:HERNANDEZ, LESLIE L (8YEAR CERTIFIED YOGA)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:L
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:8YEAR CERTIFIED YOGA
Other - Prefix:
Other - First Name:I'M SO
Other - Middle Name:
Other - Last Name:YOGA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:REGISTED YOGA SCHOOL
Mailing Address - Street 1:15 WARREN ST APT 2
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07102-3089
Mailing Address - Country:US
Mailing Address - Phone:973-495-5255
Mailing Address - Fax:
Practice Address - Street 1:1186 RAYMOND BLVD FL 4
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102-4108
Practice Address - Country:US
Practice Address - Phone:862-236-3376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-26
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach