Healthcare Provider Details

I. General information

NPI: 1669207320
Provider Name (Legal Business Name): LESLIE VALERIE LUIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2024
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 COLUMBIA AVE STE 100
LOS ANGELES CA
90017-1209
US

IV. Provider business mailing address

515 COLUMBIA AVE STE 100
LOS ANGELES CA
90017-1209
US

V. Phone/Fax

Practice location:
  • Phone: 213-553-1884
  • Fax: 213-236-9662
Mailing address:
  • Phone: 213-553-1884
  • Fax: 213-236-9662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: