Individual
DOMINIQUE ROSA LESLIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
835 HYDE ST, SAN FRANCISCO, CA 94109-5927
(628) 235-4366
Mailing address
1049 HOWARD ST, SAN FRANCISCO, CA 94103-2822
(628) 235-4366
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
390200000X
CA
172V00000X
Community Health Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
94-2335626
—
CA
Enumeration date
12/09/2020
Last updated
12/11/2020
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