Healthcare Provider Details

I. General information

NPI: 1477186328
Provider Name (Legal Business Name): LEIF PEARSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: LEIF PERSON

II. Dates (important events)

Enumeration Date: 02/19/2020
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2655 CAMINO DEL RIO N STE 450
SAN DIEGO CA
92108-1603
US

IV. Provider business mailing address

2655 CAMINO DEL RIO N STE 450
SAN DIEGO CA
92108-1603
US

V. Phone/Fax

Practice location:
  • Phone: 858-633-4115
  • Fax: 858-341-0104
Mailing address:
  • Phone: 858-633-4115
  • Fax: 858-341-0104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1477186328
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: