Provider Demographics
NPI:1306170469
Name:LESLIE A GIESEMANN MD APC
Entity type:Organization
Organization Name:LESLIE A GIESEMANN MD APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:GIESEMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-831-7770
Mailing Address - Street 1:7770 REGENTS RD
Mailing Address - Street 2:SUITE 113-582
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-1937
Mailing Address - Country:US
Mailing Address - Phone:858-831-7770
Mailing Address - Fax:858-831-7773
Practice Address - Street 1:317 N EL CAMINO REAL STE 502
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-2816
Practice Address - Country:US
Practice Address - Phone:858-831-7770
Practice Address - Fax:858-831-7773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-22
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA627132086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA62713OtherMEDICAL LICENSE