Provider Demographics
NPI:1164141727
Name:LEROY, JACQUELINE ORIANNA
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:ORIANNA
Last Name:LEROY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:895 KUHN DRIVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91902
Mailing Address - Country:US
Mailing Address - Phone:619-864-7070
Mailing Address - Fax:
Practice Address - Street 1:895 KUHN DRIVE
Practice Address - Street 2:SUITE 110
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91902
Practice Address - Country:US
Practice Address - Phone:619-864-7070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician