Provider Demographics
NPI:1740488865
Name:QUINONEZ, LESLEY GABRIELA
Entity type:Individual
Prefix:
First Name:LESLEY
Middle Name:GABRIELA
Last Name:QUINONEZ
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 1:1310 TULLY RD STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95122-3054
Mailing Address - Country:US
Mailing Address - Phone:408-886-6134
Mailing Address - Fax:
Practice Address - Street 1:1310 TULLY RD STE 101
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95122-3054
Practice Address - Country:US
Practice Address - Phone:408-886-6134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator