Healthcare Provider Details

I. General information

NPI: 1114513561
Provider Name (Legal Business Name): HEATHER OBOYLE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2020
Last Update Date: 12/18/2020
Certification Date: 12/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7580 SETON HALL ST
LA MESA CA
91942-1706
US

IV. Provider business mailing address

7580 SETON HALL ST
LA MESA CA
91942-1706
US

V. Phone/Fax

Practice location:
  • Phone: 619-806-1458
  • Fax:
Mailing address:
  • Phone: 619-806-1458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number72274
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: