Healthcare Provider Details

I. General information

NPI: 1831214949
Provider Name (Legal Business Name): LESLIE DOZZO PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6611 GULTON CT NE
ALBUQUERQUE NM
87109-4407
US

IV. Provider business mailing address

6141 THUNDERBIRD CIR NW
ALBUQUERQUE NM
87120-2163
US

V. Phone/Fax

Practice location:
  • Phone: 505-296-3965
  • Fax:
Mailing address:
  • Phone: 505-296-3965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number735
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: