Provider Demographics
NPI:1457371239
Name:LESLIE C MORETTI MD INC
Entity Type:Organization
Organization Name:LESLIE C MORETTI MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:C
Authorized Official - Last Name:MORETTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-992-8500
Mailing Address - Street 1:1850 SULLIVAN AVE
Mailing Address - Street 2:SUITE 440
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-2221
Mailing Address - Country:US
Mailing Address - Phone:650-992-8500
Mailing Address - Fax:650-992-5292
Practice Address - Street 1:1850 SULLIVAN AVE
Practice Address - Street 2:SUITE 440
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-2221
Practice Address - Country:US
Practice Address - Phone:650-992-8500
Practice Address - Fax:650-992-5292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG15299207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ79985ZMedicare PIN
CAA39488Medicare UPIN