Healthcare Provider Details

I. General information

NPI: 1033439674
Provider Name (Legal Business Name): LESLIE ALLYSON RICHARD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2010
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1136 WOTKYNS DR
PASADENA CA
91103-2838
US

IV. Provider business mailing address

1136 WOTKYNS DR
PASADENA CA
91103-2838
US

V. Phone/Fax

Practice location:
  • Phone: 626-683-0866
  • Fax:
Mailing address:
  • Phone: 626-377-0743
  • Fax: 626-866-9911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG069364
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License NumberG069364
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: