Healthcare Provider Details

I. General information

NPI: 1205031846
Provider Name (Legal Business Name): LOUISLESKOM.D. PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2007
Last Update Date: 05/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2645 OCEAN AVE 301
SAN FRANCISCO CA
94132-1633
US

IV. Provider business mailing address

2645 OCEAN AVE 301
SAN FRANCISCO CA
94132-1633
US

V. Phone/Fax

Practice location:
  • Phone: 415-333-6706
  • Fax: 415-333-6174
Mailing address:
  • Phone: 415-333-6706
  • Fax: 415-333-6174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberA17545CA
License Number StateCA

VIII. Authorized Official

Name: DR. LOUIS LESKO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 415-333-6706