Healthcare Provider Details

I. General information

NPI: 1972484871
Provider Name (Legal Business Name): LESLIE TREVINO BUCKMASTER MSW, ASW, PPSC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2025
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2613 W ORANGE AVE
ANAHEIM CA
92804-3201
US

IV. Provider business mailing address

2613 W ORANGE AVE
ANAHEIM CA
92804-3201
US

V. Phone/Fax

Practice location:
  • Phone: 714-527-2217
  • Fax:
Mailing address:
  • Phone: 562-527-2217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number240125862
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: