Healthcare Provider Details

I. General information

NPI: 1154417269
Provider Name (Legal Business Name): LESLIE MARIE URENA HEALTH SERVICES TECH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5201 LEE RD
BUZZARDS BAY MA
02542-1313
US

IV. Provider business mailing address

5677 WRIGHT ST APT B
BUZZARDS BAY MA
02542-1047
US

V. Phone/Fax

Practice location:
  • Phone: 508-968-6582
  • Fax: 508-968-6581
Mailing address:
  • Phone: 508-968-6582
  • Fax: 508-968-6581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: