Provider Demographics
NPI:1962644575
Name:SIERRA GUZMAN, LESLIE ANN (SP)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:ANN
Last Name:SIERRA GUZMAN
Suffix:
Gender:F
Credentials:SP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13840 ROSECRANS AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA FE SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:90670-5208
Mailing Address - Country:US
Mailing Address - Phone:562-305-0160
Mailing Address - Fax:562-802-3785
Practice Address - Street 1:13840 ROSECRANS AVE
Practice Address - Street 2:
Practice Address - City:SANTA FE SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:90670-5208
Practice Address - Country:US
Practice Address - Phone:562-305-0160
Practice Address - Fax:562-802-3785
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-27
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17392235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW15205AMedicare PIN