Healthcare Provider Details

I. General information

NPI: 1386128684
Provider Name (Legal Business Name): JENNIFER GODFREY LEP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2018
Last Update Date: 09/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3150 EL CAMINO REAL STE G
CARLSBAD CA
92008-2110
US

IV. Provider business mailing address

PO BOX 601422
SAN DIEGO CA
92160-1422
US

V. Phone/Fax

Practice location:
  • Phone: 619-383-6700
  • Fax: 619-383-6701
Mailing address:
  • Phone: 619-383-6700
  • Fax: 619-383-6701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: