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General NPI Number Information
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NPI Number | 1972301331
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Entity Type | Individual
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Provider Name | LESLIE JOANNA CAMACHO MACIEL R1480640922
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Gender | Female
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Dates
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Enumeration Date | 03/03/2025
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Last Update Date | 03/03/2025
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Provider Practice Location Address
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Address Line | 4443 30TH ST
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City | SAN DIEGO
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State | CA
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Zip | 92116-4288
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Country | US
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Telephone | 619-597-7335
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Fax |
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Provider Business Mailing Address
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Address Line | 2348 RUSSELL PARK WAY APT 733
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City | SAN DIEGO
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State | CA
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Zip | 92108-1345
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Country | US
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Telephone | 619-794-8762
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Fax |
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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