Provider Demographics
NPI:1245804004
Name:LEAL, JORGE
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:
Last Name:LEAL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7120 HAYVENHURST AVE STE 322
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-3813
Mailing Address - Country:US
Mailing Address - Phone:800-930-5773
Mailing Address - Fax:800-930-7957
Practice Address - Street 1:14500 ROSCOE BLVD FL 4
Practice Address - Street 2:
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-4194
Practice Address - Country:US
Practice Address - Phone:661-741-2561
Practice Address - Fax:800-852-3387
Is Sole Proprietor?:No
Enumeration Date:2021-05-17
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst