Healthcare Provider Details

I. General information

NPI: 1235277781
Provider Name (Legal Business Name): LEAH ANDREA WELCH PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2007
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12677 EVERSTON RD
SAN DIEGO CA
92128-5039
US

IV. Provider business mailing address

12677 EVERSTON RD
SAN DIEGO CA
92128-5039
US

V. Phone/Fax

Practice location:
  • Phone: 858-382-8816
  • Fax:
Mailing address:
  • Phone: 858-382-8816
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberCA PSY 17006
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number17006
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: