Healthcare Provider Details

I. General information

NPI: 1164613634
Provider Name (Legal Business Name): LESLEE H DEVIES D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2007
Last Update Date: 04/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2480 SONOMA ST
REDDING CA
96001-3027
US

IV. Provider business mailing address

PO BOX 511247
PENNGROVE CA
94951-1247
US

V. Phone/Fax

Practice location:
  • Phone: 530-225-7800
  • Fax:
Mailing address:
  • Phone: 530-515-8438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number20A10114
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number20A10114
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: