Provider Demographics
NPI:1376422576
Name:ESTRADA GONZALEZ, LESLIE GUADALUPE
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:GUADALUPE
Last Name:ESTRADA GONZALEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2307 23RD ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NE
Mailing Address - Zip Code:68601-3303
Mailing Address - Country:US
Mailing Address - Phone:402-564-5105
Mailing Address - Fax:
Practice Address - Street 1:2307 23RD ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601-3303
Practice Address - Country:US
Practice Address - Phone:402-564-5105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-01
Last Update Date:2025-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE18728183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist