Healthcare Provider Details

I. General information

NPI: 1326054578
Provider Name (Legal Business Name): LESLIE DANIELS QUINN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LESLIE JO DANIELS

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 01/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2346 N CENTRAL AVE
PHOENIX AZ
85004-1329
US

IV. Provider business mailing address

1919 E THOMAS RD BLDG 2108, STE 101
PHOENIX AZ
85016-7710
US

V. Phone/Fax

Practice location:
  • Phone: 602-282-0078
  • Fax: 602-282-0102
Mailing address:
  • Phone: 602-512-8030
  • Fax: 602-512-8161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number17707
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code2080C0008X
TaxonomyChild Abuse Pediatrics Physician
License Number17707
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: