Healthcare Provider Details

I. General information

NPI: 1518249168
Provider Name (Legal Business Name): LESLIE SMART M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2011
Last Update Date: 05/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 4TH AVE
SAN DIEGO CA
92101-2303
US

IV. Provider business mailing address

2001 4TH AVE
SAN DIEGO CA
92101-2303
US

V. Phone/Fax

Practice location:
  • Phone: 619-446-1883
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA94716
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code246Y00000X
TaxonomyHealth Information Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: