Individual
DR. LESLIE ALISON MARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
5222 BALBOA AVE, SIXTH FLOOR, SAN DIEGO, CA 92117-6904
(858) 292-0204
(858) 292-0514
Mailing address
5222 BALBOA AVE, SIXTH FLOOR, SAN DIEGO, CA 92117-6904
(858) 292-0204
(858) 292-0514
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
G36164
CA
207ND0101X
MOHS-Micrographic Surgery Physician
G36164
CA
207NS0135X
Procedural Dermatology Physician
G36164
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G361640
—
CA
01
—
G36164
CA STATE LICENSE
CA
Enumeration date
06/05/2006
Last updated
05/05/2008
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