Healthcare Provider Details

I. General information

NPI: 1275442725
Provider Name (Legal Business Name): JORGE ALEJANDRO LEOS DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11230 SORRENTO VALLEY RD STE 221
SAN DIEGO CA
92121-1300
US

IV. Provider business mailing address

11230 SORRENTO VALLEY RD STE 221
SAN DIEGO CA
92121-1300
US

V. Phone/Fax

Practice location:
  • Phone: 858-755-0889
  • Fax:
Mailing address:
  • Phone: 858-755-0889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License NumberDC377738
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: