Healthcare Provider Details

I. General information

NPI: 1942162466
Provider Name (Legal Business Name): LESLY MICHELLE DEL CID
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2025
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1457 SERENO DR
MANTECA CA
95337-7000
US

IV. Provider business mailing address

8024 BRIDGEBURN CT
ELK GROVE CA
95758-6601
US

V. Phone/Fax

Practice location:
  • Phone: 209-884-2424
  • Fax:
Mailing address:
  • Phone: 916-385-9685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: