Individual
LEOPOLDO EZETA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
865 3RD AVE STE 112, CHULA VISTA, CA 91911-1300
(619) 271-7992
Mailing address
865 3RD AVE STE 112, CHULA VISTA, CA 91911-1300
(619) 271-7992
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
09/10/2018
Last updated
10/26/2022
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