Provider Demographics
NPI:1295955847
Name:AXELROD, LESLIE J (ND)
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:J
Last Name:AXELROD
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4628 E CALLE REDONDA
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-2907
Mailing Address - Country:US
Mailing Address - Phone:602-377-1440
Mailing Address - Fax:
Practice Address - Street 1:8010 E MCDOWELL RD
Practice Address - Street 2:SUITE 111
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85257-3867
Practice Address - Country:US
Practice Address - Phone:480-970-0000
Practice Address - Fax:480-970-0003
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ87-390175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath