MEDICARE: LEAH PRIJOLES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	18500	CA

General Provider Information

NPI Number	:	1093293557
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEAH PRIJOLES

Provider Business Mailing Address
First Line	:	1254 SANTA VICTORIA RD UNIT 3
Second Line	:
City	:	CHULA VISTA
State	:	CA
Zip	:	91913-3253
Country	:	US
Telephone Number	:	619-246-7177
Fax Number	:

Provider Business Practice Location Address
First Line	:	1415 RIDGEBACK RD STE 2
Second Line	:
City	:	CHULA VISTA
State	:	CA
Zip	:	91910-6983
Country	:	US
Telephone Number	:	757-650-6636
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/06/2018
Last Update Date	:	08/06/2018

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Directions to “ LEAH PRIJOLES ” Practice Location

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