Provider Demographics
NPI:1548479165
Name:ADELMAN, LESLYE (IBCLC)
Entity type:Individual
Prefix:
First Name:LESLYE
Middle Name:
Last Name:ADELMAN
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4634
Mailing Address - Street 2:
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91617-0634
Mailing Address - Country:US
Mailing Address - Phone:818-789-6718
Mailing Address - Fax:818-789-1259
Practice Address - Street 1:13037 MAGNOLIA BLVD
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-1679
Practice Address - Country:US
Practice Address - Phone:818-789-6718
Practice Address - Fax:818-789-1259
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC2828784332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment