Healthcare Provider Details

I. General information

NPI: 1639466691
Provider Name (Legal Business Name): LESLIE A KANDEL PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2011
Last Update Date: 03/21/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 MUIR RD BLDG R-4
MARTINEZ CA
94553-4668
US

IV. Provider business mailing address

150 MUIR RD BLDG R-4
MARTINEZ CA
94553-4668
US

V. Phone/Fax

Practice location:
  • Phone: 925-370-4120
  • Fax:
Mailing address:
  • Phone: 925-370-4120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number1384
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: