Healthcare Provider Details

I. General information

NPI: 1861946261
Provider Name (Legal Business Name): LEYLA OTAROLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2016
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 W LANCASTER BLVD STE 115
LANCASTER CA
93534-2303
US

IV. Provider business mailing address

815 W LANCASTER BLVD
LANCASTER CA
93534-2303
US

V. Phone/Fax

Practice location:
  • Phone: 661-903-8822
  • Fax: 661-903-8860
Mailing address:
  • Phone: 661-903-8822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW138914
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: