Healthcare Provider Details

I. General information

NPI: 1376921379
Provider Name (Legal Business Name): CARA MCEACHIN LEP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CARA YETZ

II. Dates (important events)

Enumeration Date: 05/11/2015
Last Update Date: 11/07/2022
Certification Date: 11/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41856 IVY STREET SUITE 205
MURRIETA CA
92562
US

IV. Provider business mailing address

1148 MASTEPEICE DRIVE
OCEANSIDE CA
92057
US

V. Phone/Fax

Practice location:
  • Phone: 951-396-5701
  • Fax:
Mailing address:
  • Phone: 540-521-3972
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number4268
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: