Provider Demographics
NPI:1851508238
Name:MIAO, LESLIE LILAN
Entity Type:Individual
Prefix:MR
First Name:LESLIE
Middle Name:LILAN
Last Name:MIAO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6481 BANTRY BAY ST
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-1768
Mailing Address - Country:US
Mailing Address - Phone:650-996-0902
Mailing Address - Fax:
Practice Address - Street 1:1333 WILLOW PASS RD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-7930
Practice Address - Country:US
Practice Address - Phone:925-825-1793
Practice Address - Fax:925-825-7094
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health