Healthcare Provider Details

I. General information

NPI: 1962378232
Provider Name (Legal Business Name): MARY INZIRILLO LEP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2025
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9530 PATHWAY STREET #104 SUITE A
SANTEE CA
92071
US

IV. Provider business mailing address

9530 PATHWAY STREET #104 SUITE A
SANTEE CA
92071
US

V. Phone/Fax

Practice location:
  • Phone: 619-335-3483
  • Fax:
Mailing address:
  • Phone: 619-335-3483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number4668
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: