Healthcare Provider Details

I. General information

NPI: 1124963624
Provider Name (Legal Business Name): LESLIE MAGANA ARIAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2026
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 COLUMBIA AVE STE 200
LOS ANGELES CA
90017-1209
US

IV. Provider business mailing address

905 E 8TH ST
LOS ANGELES CA
90021-1848
US

V. Phone/Fax

Practice location:
  • Phone: 213-434-1669
  • Fax:
Mailing address:
  • Phone: 213-553-1892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: