Provider Demographics
NPI:1780267963
Name:ALLEN, LESLIE
Entity type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:
Last Name:ALLEN
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 1:711 D ST STE 108
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-3703
Mailing Address - Country:US
Mailing Address - Phone:415-925-1333
Mailing Address - Fax:415-925-1444
Practice Address - Street 1:711 D ST STE 108
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-3703
Practice Address - Country:US
Practice Address - Phone:415-925-1333
Practice Address - Fax:415-925-1444
Is Sole Proprietor?:No
Enumeration Date:2021-05-04
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CP5211224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist