Healthcare Provider Details

I. General information

NPI: 1427935857
Provider Name (Legal Business Name): MS. LESLEY NICOLE WASHINGTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2025
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4295 BROCKTON AVE
RIVERSIDE CA
92501-3446
US

IV. Provider business mailing address

5870 ARLINGTON AVE
RIVERSIDE CA
92504-2037
US

V. Phone/Fax

Practice location:
  • Phone: 951-683-6596
  • Fax:
Mailing address:
  • Phone: 951-683-6596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberACSW126242
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: