Healthcare Provider Details

I. General information

NPI: 1225615271
Provider Name (Legal Business Name): HELENE LEONARD SUDCC III
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2021
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4283 EL CAJON BLVD STE 100
SAN DIEGO CA
92105-1289
US

IV. Provider business mailing address

4283 EL CAJON BLVD STE 100
SAN DIEGO CA
92105-1289
US

V. Phone/Fax

Practice location:
  • Phone: 619-521-1743
  • Fax: 619-393-0242
Mailing address:
  • Phone: 619-521-1743
  • Fax: 619-393-0242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: