Healthcare Provider Details

I. General information

NPI: 1437064532
Provider Name (Legal Business Name): RANDY MI LESINSKY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 6TH AVE SPC 400
HACIENDA HEIGHTS CA
91745-1229
US

IV. Provider business mailing address

2650 E FOOTHILL BLVD
PASADENA CA
91107-3439
US

V. Phone/Fax

Practice location:
  • Phone: 626-511-2261
  • Fax: 626-577-2543
Mailing address:
  • Phone: 626-577-2261
  • Fax: 626-577-2543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: