Provider Demographics
NPI:1134955123
Name:PYLES, LESLIE RAE
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:RAE
Last Name:PYLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:RAE
Other - Last Name:CIENEGA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3076 MARLOW RD APT F130
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-6944
Mailing Address - Country:US
Mailing Address - Phone:707-340-5943
Mailing Address - Fax:
Practice Address - Street 1:3076 MARLOW RD APT F130
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-6944
Practice Address - Country:US
Practice Address - Phone:707-340-5943
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker