Provider Demographics
NPI:1861682361
Name:BELFANTI, LESLIE ANN (RD CDE LD)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:ANN
Last Name:BELFANTI
Suffix:
Gender:F
Credentials:RD CDE LD
Other - Prefix:MISS
Other - First Name:LESLIE
Other - Middle Name:ANN
Other - Last Name:FREITAG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD CDE LD
Mailing Address - Street 1:615 SNEAD DR N
Mailing Address - Street 2:
Mailing Address - City:KEIZER
Mailing Address - State:OR
Mailing Address - Zip Code:97303
Mailing Address - Country:US
Mailing Address - Phone:503-370-9687
Mailing Address - Fax:
Practice Address - Street 1:5125 SKYLINE ROAD SOUTH
Practice Address - Street 2:KAISER PERMANENTE SKYLINE MEDICAL OFFICE
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97306-9413
Practice Address - Country:US
Practice Address - Phone:503-588-5951
Practice Address - Fax:503-588-5958
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR000504133V00000X
724230133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR114467Medicare PIN