Provider Information for 1275906307
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LESA LEIDEN
Sex: Female
NPI: 1275906307
Last Updated: 2015-11-11
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1275906307 | ||||||||
| Enumeration Date | 2015-11-11 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 1161 BIRDNECK LAKE DR VIRGINIA BEACH, VA 23451-6615 United States Phone: 757-515-5559 | Fax: | ||||||||
| Primary Practice Address | 762 INDEPENDENCE BLVD STE 100C VIRGINIA BEACH, VA 23455-6200 United States Phone: 757-515-5559 | Fax: | ||||||||
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