Provider Demographics
NPI:1477386407
Name:HARRIS, LESLIE CAMELLIA
Entity type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:CAMELLIA
Last Name:HARRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:LESLIE
Other - Middle Name:CAMELLIA
Other - Last Name:FREEMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 883112
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94188-3112
Mailing Address - Country:US
Mailing Address - Phone:415-937-3375
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 883112
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94188-3112
Practice Address - Country:US
Practice Address - Phone:415-937-3375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-23
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program