Healthcare Provider Details

I. General information

NPI: 1225633167
Provider Name (Legal Business Name): ESMERALDA M HUIZAR LEON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2020
Last Update Date: 02/01/2023
Certification Date: 01/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3240 KENYON STREET
SAN DIEGO CA
92110-5001
US

IV. Provider business mailing address

3420 KENYON ST
SAN DIEGO CA
92110-5001
US

V. Phone/Fax

Practice location:
  • Phone: 619-221-6550
  • Fax:
Mailing address:
  • Phone: 619-221-6550
  • Fax: 619-221-6556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number87618
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: