Healthcare Provider Details

I. General information

NPI: 1972099489
Provider Name (Legal Business Name): LESLIE ANN GILBERT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2018
Last Update Date: 07/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23077 THREE NOTCH RD STE 101
CALIFORNIA MD
20619
US

IV. Provider business mailing address

1101 BRICKELL AVE STE N1700
MIAMI FL
33131-3105
US

V. Phone/Fax

Practice location:
  • Phone: 301-737-4040
  • Fax:
Mailing address:
  • Phone: 786-563-4010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number01456
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: