Provider Demographics
NPI:1285807552
Name:JIMENEZ-DIAZ, LESLEY
Entity type:Individual
Prefix:
First Name:LESLEY
Middle Name:
Last Name:JIMENEZ-DIAZ
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 1:3822 SALTY MARSH
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78245-2746
Mailing Address - Country:US
Mailing Address - Phone:817-526-4444
Mailing Address - Fax:
Practice Address - Street 1:3822 SALTY MARSH
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78245-2746
Practice Address - Country:US
Practice Address - Phone:817-526-4444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR60471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical