Healthcare Provider Details

I. General information

NPI: 1033592159
Provider Name (Legal Business Name): LESLIE WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2015
Last Update Date: 05/20/2024
Certification Date: 05/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 W 6TH ST STE 113
TEMPE AZ
85281-3814
US

IV. Provider business mailing address

2828 N CENTRAL AVE STE 1021
PHOENIX AZ
85004-1021
US

V. Phone/Fax

Practice location:
  • Phone: 844-427-6966
  • Fax:
Mailing address:
  • Phone: 844-427-6966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175L00000X
TaxonomyHomeopath
License Number400315001058
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberHLPC
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: