Provider Demographics
NPI:1124110309
Name:DELANEY, LESLIE ROBERTA (MD)
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:ROBERTA
Last Name:DELANEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 LA CASA VIA STE 209
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-3034
Mailing Address - Country:US
Mailing Address - Phone:925-988-9333
Mailing Address - Fax:925-988-9335
Practice Address - Street 1:130 LA CASA VIA STE 209
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3034
Practice Address - Country:US
Practice Address - Phone:925-988-9333
Practice Address - Fax:925-988-9335
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG85784207LP2900X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG75605Medicare UPIN
CA00G857841Medicare ID - Type Unspecified