Healthcare Provider Details

I. General information

NPI: 1437037587
Provider Name (Legal Business Name): LESLIE MEZA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2025
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 SPRUCE ST STE 250
RIVERSIDE CA
92507-7429
US

IV. Provider business mailing address

4512 SUBURBAN RD
STOCKTON CA
95215-1828
US

V. Phone/Fax

Practice location:
  • Phone: 760-792-0856
  • Fax:
Mailing address:
  • Phone: 209-471-1584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: