Provider Demographics
NPI:1023843158
Name:LESLIE, ERIC
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:LESLIE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 892
Mailing Address - Street 2:
Mailing Address - City:MOUNT SHASTA
Mailing Address - State:CA
Mailing Address - Zip Code:96067-0892
Mailing Address - Country:US
Mailing Address - Phone:530-717-3667
Mailing Address - Fax:
Practice Address - Street 1:10908 BLACKFOOT RD
Practice Address - Street 2:
Practice Address - City:MONTAGUE
Practice Address - State:CA
Practice Address - Zip Code:96064-9797
Practice Address - Country:US
Practice Address - Phone:530-717-3667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-06
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)