Healthcare Provider Details

I. General information

NPI: 1720837065
Provider Name (Legal Business Name): LESLIE DERAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2024
Last Update Date: 05/17/2024
Certification Date: 05/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5138 GEARY BLVD
SAN FRANCISCO CA
94118-2816
US

IV. Provider business mailing address

5138 GEARY BLVD
SAN FRANCISCO CA
94118-2816
US

V. Phone/Fax

Practice location:
  • Phone: 415-742-4440
  • Fax:
Mailing address:
  • Phone: 415-742-4440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number8994
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: