Healthcare Provider Details

I. General information

NPI: 1033822127
Provider Name (Legal Business Name): KRYSTLE M PUMAREJO LEP, MS, PPS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KRYSTLE M OROZCO LEP, MS, PPS

II. Dates (important events)

Enumeration Date: 01/04/2023
Last Update Date: 01/05/2023
Certification Date: 01/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4470 W SUNSET BLVD STE
LOS ANGELES CA
90027-6309
US

IV. Provider business mailing address

6240 W PALO ALTO AVE
FRESNO CA
93722-2001
US

V. Phone/Fax

Practice location:
  • Phone: 323-798-7413
  • Fax: 833-419-0181
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberLEP3413
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: