Provider Demographics
NPI:1902373293
Name:DEJESUS, LESLIE A
Entity Type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:A
Last Name:DEJESUS
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 1:460 CHAPEL TRACE DR APT 301
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32807-6520
Mailing Address - Country:US
Mailing Address - Phone:407-234-6137
Mailing Address - Fax:
Practice Address - Street 1:460 CHAPEL TRACE DR APT 301
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807-6520
Practice Address - Country:US
Practice Address - Phone:407-234-6137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-25
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator