Individual
LESLIE RICHARDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.D.
Contact information
Practice address
1318 JOHNSON AVE, SAN LUIS OBISPO, CA 93401-3314
(805) 541-2300
(805) 541-2301
Mailing address
1241 JOHNSON AVE, SUITE 200, SAN LUIS OBISPO, CA 93401-3306
(805) 541-2300
(805) 541-2301
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
508178
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CB209886
MEDICARE PTAN
CA
Enumeration date
07/12/2006
Last updated
07/24/2014
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