Healthcare Provider Details

I. General information

NPI: 1972063006
Provider Name (Legal Business Name): JOHN LESO DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2019
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

736 CAMBRIDGE ST, 2ND FL BLDG C 7TH FL
BRIGHTON MA
02135
US

IV. Provider business mailing address

960 MASSACHUSETTS AVE FL 2
BOSTON MA
02118
US

V. Phone/Fax

Practice location:
  • Phone: 617-789-2344
  • Fax: 617-789-2975
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number64189
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number1027986
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number1027986
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: