Healthcare Provider Details

I. General information

NPI: 1316680168
Provider Name (Legal Business Name): LESLEY YESENIA ESPANOLA DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2022
Last Update Date: 04/19/2022
Certification Date: 04/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4601 DALE RD
MODESTO CA
95356-9718
US

IV. Provider business mailing address

870 WESTLEIGH CT
TRACY CA
95376-2457
US

V. Phone/Fax

Practice location:
  • Phone: 209-735-5000
  • Fax:
Mailing address:
  • Phone: 209-834-6191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number297344
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: