Healthcare Provider Details

I. General information

NPI: 1861821720
Provider Name (Legal Business Name): LESLIE GOTTESMAN LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2013
Last Update Date: 11/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 QUINTANA RD SUITE 1B
MORRO BAY CA
93442-2300
US

IV. Provider business mailing address

800 QUINTANA RD SUITE 1B
MORRO BAY CA
93442-2300
US

V. Phone/Fax

Practice location:
  • Phone: 805-772-6131
  • Fax: 805-772-5281
Mailing address:
  • Phone: 805-772-6131
  • Fax: 805-772-5281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberCA37947
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: