Healthcare Provider Details

I. General information

NPI: 1164993499
Provider Name (Legal Business Name): DAVITA LESCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2018
Last Update Date: 08/11/2021
Certification Date: 07/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WRIGHT INSTITUTE CLINICAL SERVICES 1819 UNIVERSITY AVENUE SUITE 2B
BERKELEY CA
94704
US

IV. Provider business mailing address

206 N JACKSON ST STE 202
GLENDALE CA
91206-4330
US

V. Phone/Fax

Practice location:
  • Phone: 510-548-9716
  • Fax:
Mailing address:
  • Phone: 818-241-6780
  • Fax: 818-241-6853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: