Healthcare Provider Details

I. General information

NPI: 1740172410
Provider Name (Legal Business Name): MRS. LESLIE CALESTINI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LESLIE ROEN

II. Dates (important events)

Enumeration Date: 07/17/2025
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

564 MOUNTAIN RANCH RD
SAN ANDREAS CA
95249-9782
US

IV. Provider business mailing address

166 ASHWORTH DR
IONE CA
95640-5435
US

V. Phone/Fax

Practice location:
  • Phone: 209-256-3916
  • Fax:
Mailing address:
  • Phone: 209-256-3916
  • 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: