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General NPI Number Information
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NPI Number | 1619150513
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Entity Type | Organization
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Legal Business Name | LESLIE A. SQUIRES, MD., INC.
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Dates
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Enumeration Date | 12/13/2007
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Last Update Date | 04/16/2008
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Provider Practice Location Address
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Address Line | 45 CASTRO ST STE 338
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City | SAN FRANCISCO
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State | CA
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Zip | 94114-1010
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Country | US
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Telephone | 415-621-6886
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Fax |
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Provider Business Mailing Address
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Address Line | 45 CASTRO ST STE 338
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City | SAN FRANCISCO
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State | CA
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Zip | 94114-1010
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Country | US
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Telephone | 415-621-6886
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | LESLIE ALLEN SQUIRES
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Credential |
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Telephone | 415-621-6886
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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