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NPI Code Detail

MEDICARE: LESLIE CARDENAS GORDON

MEDICARE: LESLIE CARDENAS GORDON
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
1106S00000XBehavior Technician
2103K00000XBehavior Analyst

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1669964987
Entity Type Code : Individual
Provider Name (Legal Business Name) : LESLIE CARDENAS GORDON
Provider Business Mailing Address
First Line : 1262 PERSIMMON AVE APT 1
Second Line :
City : EL CAJON
State : CA
Zip : 92021-4979
Country : US
Telephone Number : 619-368-0771
Fax Number :
Provider Business Practice Location Address
First Line : 2820 CAMINO DEL RIO S STE 100
Second Line :
City : SAN DIEGO
State : CA
Zip : 92108-3822
Country : US
Telephone Number : 619-549-6608
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2018
Last Update Date : 06/06/2024

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Directions to “ LESLIE CARDENAS GORDON ” Practice Location

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