Provider Demographics
NPI:1154335750
Name:WILKINSON, LESLEY D (MD)
Entity type:Individual
Prefix:DR
First Name:LESLEY
Middle Name:D
Last Name:WILKINSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:
Other - Last Name:KLUMPP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 232410
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92193-2410
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 WEST ARBOR DR MC 0807
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-0807
Practice Address - Country:US
Practice Address - Phone:858-657-8600
Practice Address - Fax:858-657-8625
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG74239207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G742390OtherMEDICAL PPIN #
CA00G742390OtherMEDICAL PPIN #
CAWG74239AMedicare ID - Type UnspecifiedPPIN #
CAWG74239CMedicare ID - Type UnspecifiedPPIN #