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General NPI Number Information
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NPI Number | 1508974767
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Entity Type | Individual
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Provider Name | LESLIE MARIE RADENTZ MD
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Gender | Female
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Dates
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Enumeration Date | 08/28/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 39755 MURRIETA HOT SPRINGS RD A130
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City | MURRIETA
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State | CA
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Zip | 92563
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Country | US
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Telephone | 951-600-3946
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Fax | 951-304-2203
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Provider Business Mailing Address
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Address Line | 39755 MURRIETA HOT SPRINGS RD A130
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City | MURRIETA
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State | CA
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Zip | 92563
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Country | US
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Telephone | 951-600-3946
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Fax | 951-304-2203
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | A721570
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License Number State | CA
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