Provider Demographics
NPI:1225168495
Name:JOSEPH, LEELA E (PHN)
Entity Type:Individual
Prefix:
First Name:LEELA
Middle Name:E
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 MONTEREY VISTA WAY
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-3956
Mailing Address - Country:US
Mailing Address - Phone:760-943-1462
Mailing Address - Fax:
Practice Address - Street 1:6950 LEVANT ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-6010
Practice Address - Country:US
Practice Address - Phone:858-694-5728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN 385510163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse