Healthcare Provider Details

I. General information

NPI: 1871332510
Provider Name (Legal Business Name): LEIZEL COLLO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2024
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2990 JAMACHA RD STE 240
EL CAJON CA
92019-4386
US

IV. Provider business mailing address

33225 VERMONT RD
TEMECULA CA
92592-8009
US

V. Phone/Fax

Practice location:
  • Phone: 619-630-7793
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: