Provider Demographics
NPI:1316683832
Name:LESLIE, ALBERTO
Entity type:Individual
Prefix:MR
First Name:ALBERTO
Middle Name:
Last Name:LESLIE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:756 TYVOLA RD STE 116
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28217-3535
Mailing Address - Country:US
Mailing Address - Phone:646-270-2269
Mailing Address - Fax:
Practice Address - Street 1:756 TYVOLA RD STE 116
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28217-3535
Practice Address - Country:US
Practice Address - Phone:646-270-2269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-08
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Yes175T00000XOther Service ProvidersPeer Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ106847Medicaid