MEDICARE: LESLIE DORTICOS

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
1	106H00000X	Marriage & Family Therapist	161204	CA

General Provider Information

NPI Number	:	1326411893
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE DORTICOS

Provider Business Mailing Address
First Line	:	1400 W EDGEHILL RD APT 44
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92405-5136
Country	:	US
Telephone Number	:	909-215-0365
Fax Number	:

Provider Business Practice Location Address
First Line	:	1400 W EDGEHILL RD APT 44
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92405-5136
Country	:	US
Telephone Number	:	909-215-0365
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/05/2015
Last Update Date	:	02/07/2026

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Directions to “ LESLIE DORTICOS ” Practice Location

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