Provider Demographics
NPI:1942477021
Name:BAEZA, LESLIE (DPM)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:BAEZA
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4605 FRANKFORD AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19124-5803
Mailing Address - Country:US
Mailing Address - Phone:215-289-7007
Mailing Address - Fax:215-289-3400
Practice Address - Street 1:4605 FRANKFORD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19124-5803
Practice Address - Country:US
Practice Address - Phone:215-289-7007
Practice Address - Fax:215-289-3400
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-08
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC006020213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist