Healthcare Provider Details

I. General information

NPI: 1326206723
Provider Name (Legal Business Name): LESLIE CUNNINGHAM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2008
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2019 GALISTEO ST SUITE N-2
SANTA FE NM
87505-2143
US

IV. Provider business mailing address

2019 GALISTEO ST SUITE N-2
SANTA FE NM
87505-2143
US

V. Phone/Fax

Practice location:
  • Phone: 505-699-8389
  • Fax: 505-983-0071
Mailing address:
  • Phone: 505-699-8389
  • Fax: 505-983-0071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number83-183
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: