Healthcare Provider Details

I. General information

NPI: 1871023432
Provider Name (Legal Business Name): LESLIE A. STOREY, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7777 N. INGRAM AVE.
FRESNO CA
93711-6281
US

IV. Provider business mailing address

4388 N WILSON AVE
FRESNO CA
93704-3628
US

V. Phone/Fax

Practice location:
  • Phone: 559-472-7546
  • Fax: 559-385-7733
Mailing address:
  • Phone: 559-476-0515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberA81742
License Number StateCA

VIII. Authorized Official

Name: LESLIE A. STOREY
Title or Position: OWNER
Credential: M.D.
Phone: 559-472-7546