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NPI Code Detail

MEDICARE: MARY LESLIE

MEDICARE: MARY LESLIE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior TechnicianCA

General Provider Information

NPI Number : 1619839131
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY LESLIE
Provider Business Mailing Address
First Line : 350 FAIRWAY DR STE 101
Second Line :
City : DEERFIELD BEACH
State : FL
Zip : 33441-1834
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5377 N FRESNO ST STE 103
Second Line :
City : FRESNO
State : CA
Zip : 93710-6875
Country : US
Telephone Number : 877-418-2978
Fax Number : 866-500-2186
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/02/2025
Last Update Date : 12/02/2025

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Directions to “ MARY LESLIE ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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