Provider Demographics
NPI:1972301331
Name:CAMACHO MACIEL, LESLIE JOANNA (R1480640922)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:JOANNA
Last Name:CAMACHO MACIEL
Suffix:
Gender:
Credentials:R1480640922
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2348 RUSSELL PARK WAY APT 733
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-1345
Mailing Address - Country:US
Mailing Address - Phone:619-794-8762
Mailing Address - Fax:
Practice Address - Street 1:4443 30TH ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92116-4288
Practice Address - Country:US
Practice Address - Phone:619-597-7335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)