Healthcare Provider Details

I. General information

NPI: 1174138044
Provider Name (Legal Business Name): MR. ANDREW LEIFER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2020
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 15TH ST
SAN DIEGO CA
92101-7792
US

IV. Provider business mailing address

424 15TH ST APT 3705
SAN DIEGO CA
92101-7788
US

V. Phone/Fax

Practice location:
  • Phone: 760-399-0120
  • Fax:
Mailing address:
  • Phone: 760-399-0120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number165519
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: