Healthcare Provider Details

I. General information

NPI: 1003737602
Provider Name (Legal Business Name): LEISLA YAHAIRA BERNAL AVILA OTR/L
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 EMPEY WAY
SAN JOSE CA
95128-4705
US

IV. Provider business mailing address

730 EMPEY WAY
SAN JOSE CA
95128-4705
US

V. Phone/Fax

Practice location:
  • Phone: 408-275-1500
  • Fax:
Mailing address:
  • Phone: 408-275-1500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number29155
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: