Provider Demographics
NPI:1003253279
Name:KUBERA, LESLIE H (MA, RD, LDN)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:H
Last Name:KUBERA
Suffix:
Gender:F
Credentials:MA, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 E LANCASTER AVE
Mailing Address - Street 2:
Mailing Address - City:DOWNINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19335-2719
Mailing Address - Country:US
Mailing Address - Phone:484-680-5366
Mailing Address - Fax:484-397-0310
Practice Address - Street 1:721 E LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:DOWNINGTOWN
Practice Address - State:PA
Practice Address - Zip Code:19335-2719
Practice Address - Country:US
Practice Address - Phone:484-680-5366
Practice Address - Fax:484-397-0310
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-29
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN002850133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered