Brusatori, Leyla T

Brusatori, Leyla T is an sole proprietor health care provider with primary practice located at 1812 W Kettleman Ln Ste 3 , Lodi CA 95242-4209. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Family, Behavioral Health & Social Service Providers / Clinical Child & Adolescent. Behavioral Health & Social Service Providers / Clinical Child & Adolescent is her primary health care specialty. Brusatori, Leyla T can be contacted via phone (707) 225-2317.

Contact Information

Primary practice address
1812 W Kettleman Ln Ste 3 Lodi CA 95242-4209
Phone: (707) 225-2317
Fax: (209) 593-3000
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Family 103TF0000X PSY 23080 California
Behavioral Health & Social Service Providers / Clinical Child & Adolescent 103TC2200X PSY 23080 California

Profile Details

NPI number 1437471190
LBN Legal business name Brusatori, Leyla T
Credentials PHD
Entity Individual
Sole proprietor 1 Yes
Enumeration date Feb 23rd, 2010
Last updated Sep 25th, 2018 - about 7 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1437471190 NPPES
California MEDICAID 9940639

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