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General NPI Number Information
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NPI Number | 1760508725
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Entity Type | Organization
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Legal Business Name | LESLIE K. BARTOLF, PH.D., PROF. PSYCH. CORP.
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Dates
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Enumeration Date | 03/21/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3551 FLORISTA ST 1D
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City | LOS ALAMITOS
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State | CA
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Zip | 90720-2474
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Country | US
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Telephone | 626-398-1182
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Fax |
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Provider Business Mailing Address
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Address Line | 3551 FLORISTA ST 1D
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City | LOS ALAMITOS
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State | CA
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Zip | 90720-2474
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Country | US
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Telephone | 626-398-1182
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Fax |
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Authorized Official
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Title or Position | PRINCIPAL
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Name | DR. LESLIE BARTOLF
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Credential | PH.D.
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Telephone | 626-824-4994
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY13137
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License Number State | CA
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