Provider Demographics
NPI:1386947240
Name:CISAR, LESLIE ANNE (ND)
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:ANNE
Last Name:CISAR
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12404 S MANDAN CT
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-3900
Mailing Address - Country:US
Mailing Address - Phone:490-313-7626
Mailing Address - Fax:480-422-7063
Practice Address - Street 1:9030 S MCCLINTOCK DR
Practice Address - Street 2:STE. 105
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-4553
Practice Address - Country:US
Practice Address - Phone:480-313-7626
Practice Address - Fax:480-422-7063
Is Sole Proprietor?:No
Enumeration Date:2010-12-15
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10-1225175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath