MEDICARE: DR. LESLIE PAM PH.D.

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	MFT 04523	CA

General Provider Information

NPI Number	:	1457507121
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LESLIE PAM PH.D.

Provider Business Mailing Address
First Line	:	9185 THRASHER AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90069-1144
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10379 W PICO BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-2608
Country	:	US
Telephone Number	:	310-275-3836
Fax Number	:

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

Provider Enumeration Date	:	08/13/2008
Last Update Date	:	08/13/2008

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Directions to “ DR. LESLIE PAM PH.D.” Practice Location

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