Healthcare Provider Details

I. General information

NPI: 1033655022
Provider Name (Legal Business Name): LESDY FELLOWS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2017
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3125 MYERS ST
RIVERSIDE CA
92503-5527
US

IV. Provider business mailing address

3125 MYERS ST
RIVERSIDE CA
92503-5527
US

V. Phone/Fax

Practice location:
  • Phone: 951-358-5862
  • Fax:
Mailing address:
  • Phone: 480-953-1008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: