Provider Demographics
NPI:1851823876
Name:BORODI, LESLIE (C E ADMINISTRATOR)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:BORODI
Suffix:
Gender:M
Credentials:C E ADMINISTRATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5505 DANBURY PL
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-6833
Mailing Address - Country:US
Mailing Address - Phone:213-712-5100
Mailing Address - Fax:
Practice Address - Street 1:21746 MAYAN DR
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:CA
Practice Address - Zip Code:91311-1418
Practice Address - Country:US
Practice Address - Phone:213-712-5100
Practice Address - Fax:818-578-6519
Is Sole Proprietor?:No
Enumeration Date:2017-03-29
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician