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NPI Code Detail

MEDICARE: LES ANTHONY II

MEDICARE: LES ANTHONY II
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171M00000XCase Manager/Care Coordinator
2373H00000XDay Training/Habilitation Specialist

General Provider Information

NPI Number : 1083955710
Entity Type Code : Individual
Provider Name (Legal Business Name) : LES ANTHONY II
Provider Business Mailing Address
First Line : 5634 JEREMY WAY
Second Line :
City : STOCKTON
State : CA
Zip : 95212-2867
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5634 JEREMY WAY
Second Line :
City : STOCKTON
State : CA
Zip : 95212-2867
Country : US
Telephone Number : 209-888-4969
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/05/2013
Last Update Date : 07/03/2025

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Directions to “ LES ANTHONY II ” Practice Location

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