Provider Demographics
NPI:1982813044
Name:DALABA, LESLI TAMAR (LAC)
Entity Type:Individual
Prefix:
First Name:LESLI
Middle Name:TAMAR
Last Name:DALABA
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 10TH AVE EAST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-5708
Mailing Address - Country:US
Mailing Address - Phone:206-323-3277
Mailing Address - Fax:206-860-6807
Practice Address - Street 1:126 10TH AVE EAST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-5708
Practice Address - Country:US
Practice Address - Phone:206-323-3277
Practice Address - Fax:206-860-6807
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA50171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA50OtherSTATE LICENSE NUMBER WA D
WA62272886OtherGBI