Provider Demographics
NPI:1952963696
Name:FESILI, LEO
Entity Type:Individual
Prefix:
First Name:LEO
Middle Name:
Last Name:FESILI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13116 NE 132ND ST
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-2306
Mailing Address - Country:US
Mailing Address - Phone:425-869-6490
Mailing Address - Fax:
Practice Address - Street 1:20975 41ST PL S APT F107
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:WA
Practice Address - Zip Code:98198-4276
Practice Address - Country:US
Practice Address - Phone:206-487-8472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-02
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist