Provider Demographics
NPI:1902820400
Name:LESKO, KATHERINE
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:
Last Name:LESKO
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 1:6177 RIVER CREST DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-0728
Mailing Address - Country:US
Mailing Address - Phone:951-653-4480
Mailing Address - Fax:951-653-5051
Practice Address - Street 1:6177 RIVER CREST DR
Practice Address - Street 2:SUITE A
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-0728
Practice Address - Country:US
Practice Address - Phone:951-653-4480
Practice Address - Fax:951-653-5051
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT29559174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT29559AMedicare ID - Type UnspecifiedPPIN