Provider Demographics
NPI:1376174748
Name:LEY, JORGE (MS)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:
Last Name:LEY
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1576 DUNSMUIR CT
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91913-1579
Mailing Address - Country:US
Mailing Address - Phone:619-254-0041
Mailing Address - Fax:
Practice Address - Street 1:1576 DUNSMUIR CT
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91913-1579
Practice Address - Country:US
Practice Address - Phone:619-254-0041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-04
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Single Specialty