Provider Demographics
NPI:1568038412
Name:DEL MORAL, LETICIA MARIA (LEP)
Entity Type:Individual
Prefix:
First Name:LETICIA
Middle Name:MARIA
Last Name:DEL MORAL
Suffix:
Gender:F
Credentials:LEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33417 CORTE EBANO
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-9475
Mailing Address - Country:US
Mailing Address - Phone:951-217-4391
Mailing Address - Fax:
Practice Address - Street 1:33417 CORTE EBANO
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-9475
Practice Address - Country:US
Practice Address - Phone:951-217-4391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-01
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALEP3680103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist