Provider Demographics
NPI:1609672849
Name:LYALL, LEAH
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:LYALL
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 1:15529 HIGHWAY 76
Mailing Address - Street 2:
Mailing Address - City:PAUMA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92061-9547
Mailing Address - Country:US
Mailing Address - Phone:760-547-4302
Mailing Address - Fax:
Practice Address - Street 1:15529 HIGHWAY 76
Practice Address - Street 2:
Practice Address - City:PAUMA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92061-9547
Practice Address - Country:US
Practice Address - Phone:760-547-4302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-19
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175L00000XOther Service ProvidersHomeopath