MEDICARE: LESLIE DENISE AGIS-PATEL

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	103K00000X	Behavior Analyst		CA

General Provider Information

NPI Number	:	1750843231
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE DENISE AGIS-PATEL

Provider Business Mailing Address
First Line	:	2550 OLD ZAFERIA WAY
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90804-1552
Country	:	US
Telephone Number	:	562-505-3126
Fax Number	:

Provider Business Practice Location Address
First Line	:	555 PARKCENTER DR STE 115
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92705-3521
Country	:	US
Telephone Number	:	562-505-3126
Fax Number	:

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

Provider Enumeration Date	:	04/03/2019
Last Update Date	:	06/10/2026

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