MEDICARE: MS. MARY E LESLIE NUTRITIONIST

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	133N00000X	Nutritionist		CA
2	133NN1002X	Nutrition Education Nutritionist		CA

General Provider Information

NPI Number	:	1760685663
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY E LESLIE NUTRITIONIST

Provider Business Mailing Address
First Line	:	2012 S VICTORIA AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90016-1814
Country	:	US
Telephone Number	:	626-590-6461
Fax Number	:

Provider Business Practice Location Address
First Line	:	2012 S VICTORIA AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90016-1814
Country	:	US
Telephone Number	:	626-590-6461
Fax Number	:

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

Provider Enumeration Date	:	06/07/2007
Last Update Date	:	09/11/2025

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