Provider Demographics
NPI:1174594659
Name:EATON, LESLIE K (MD)
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:K
Last Name:EATON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:KAY ELLIS
Other - Last Name:EATON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:15013 ANILLO WAY
Mailing Address - Street 2:
Mailing Address - City:RANCHO MURIETA
Mailing Address - State:CA
Mailing Address - Zip Code:95683
Mailing Address - Country:US
Mailing Address - Phone:916-320-9039
Mailing Address - Fax:916-366-5441
Practice Address - Street 1:16033 GRISSOM AVE
Practice Address - Street 2:
Practice Address - City:MATHER
Practice Address - State:CA
Practice Address - Zip Code:95655
Practice Address - Country:US
Practice Address - Phone:916-366-5420
Practice Address - Fax:916-366-5441
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2016-04-15
Deactivation Date:2016-02-08
Deactivation Code:
Reactivation Date:2016-04-15
Provider Licenses
StateLicense IDTaxonomies
KSKS172212084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry