1588199749 NPI number — LESLY G PILLADO

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588199749 NPI number — LESLY G PILLADO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LESLY G PILLADO
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588199749
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/25/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4275 EXECUTIVE SQ
Provider Second Line Business Mailing Address:
STE 200
Provider Business Mailing Address City Name:
LA JOLLA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92037-9123
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-488-3200
Provider Business Mailing Address Fax Number:
866-272-6924

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CALLE 3RA Y AVE B
Provider Second Line Business Practice Location Address:
STE 235
Provider Business Practice Location Address City Name:
LOS ALGODONES
Provider Business Practice Location Address State Name:
BAJA CALIFORNIA
Provider Business Practice Location Address Postal Code:
21970
Provider Business Practice Location Address Country Code:
MX
Provider Business Practice Location Address Telephone Number:
658-517-3035
Provider Business Practice Location Address Fax Number:
866-272-6924
Provider Enumeration Date:
04/25/2017

Additional Information

Authorized Official

Authorized Official Last Name:
PILLADO
Authorized Official First Name:
LESLY
Authorized Official Middle Name:
GLORIA
Authorized Official Title or Position:
DENTIST
Authorized Official Telephone Number:
619-488-3200

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  6958762 , registered in the state of ZZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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