Provider Demographics
NPI:1669207320
Name:LUIS, LESLIE VALERIE
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:VALERIE
Last Name:LUIS
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 1:11741 E TELEGRAPH ROAD
Mailing Address - Street 2:SUITE #A-D, #G
Mailing Address - City:SANTA FE SPRING
Mailing Address - State:CA
Mailing Address - Zip Code:90670-3681
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11741 E TELEGRAPH ROAD
Practice Address - Street 2:SUITE #A-D, #G
Practice Address - City:SANTA FE SPRING
Practice Address - State:CA
Practice Address - Zip Code:90670-3681
Practice Address - Country:US
Practice Address - Phone:323-601-3363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-03
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program