Healthcare Provider Details

I. General information

NPI: 1255303905
Provider Name (Legal Business Name): LESLIE A DUDLEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 02/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 N MADISON AVE SUITE 800
PASADENA CA
91101-2035
US

IV. Provider business mailing address

133 N ALTADENA DR 2ND FLOOR
PASADENA CA
91107-7325
US

V. Phone/Fax

Practice location:
  • Phone: 626-792-3141
  • Fax: 626-792-9193
Mailing address:
  • Phone: 626-397-8335
  • Fax: 626-397-8337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA59598
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: