Provider Demographics
NPI:1033592159
Name:WILLIAMS, LESLIE
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:WILLIAMS
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 1:2828 N CENTRAL AVE STE 1021
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-1021
Mailing Address - Country:US
Mailing Address - Phone:844-427-6966
Mailing Address - Fax:
Practice Address - Street 1:115 W 6TH ST STE 113
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-3814
Practice Address - Country:US
Practice Address - Phone:844-427-6966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-07
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC400315001058175L00000X
NYHLPC207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No175L00000XOther Service ProvidersHomeopath