1861682361 NPI number — MRS. LESLIE ANN BELFANTI RD CDE LD

Table of content: MRS. LESLIE ANN BELFANTI RD CDE LD (NPI 1861682361)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861682361 NPI number — MRS. LESLIE ANN BELFANTI RD CDE LD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BELFANTI
Provider First Name:
LESLIE
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RD CDE LD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FREITAG
Provider Other First Name:
LESLIE
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
RD CDE LD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1861682361
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/31/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
615 SNEAD DR N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KEIZER
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97303
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-370-9687
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5125 SKYLINE ROAD SOUTH
Provider Second Line Business Practice Location Address:
KAISER PERMANENTE SKYLINE MEDICAL OFFICE
Provider Business Practice Location Address City Name:
SALEM
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97306-9413
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-588-5951
Provider Business Practice Location Address Fax Number:
503-588-5958
Provider Enumeration Date:
07/31/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  000504 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 133V00000X , with the licence number: 724230 ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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