Healthcare Provider Details

I. General information

NPI: 1083568281
Provider Name (Legal Business Name): SHELLEY RHONDA LESLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2026
Last Update Date: 02/24/2026
Certification Date: 02/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

78140 CALLE TAMPICO
LA QUINTA CA
92253-2900
US

IV. Provider business mailing address

79380 FOUR PATHS LN
BERMUDA DUNES CA
92203-1651
US

V. Phone/Fax

Practice location:
  • Phone: 760-863-7970
  • Fax:
Mailing address:
  • Phone: 760-863-7970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-KHPMCJ
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: