Provider Demographics
NPI:1023997327
Name:LEAL-TEJADA, GRISELDA (SUDRC I)
Entity type:Individual
Prefix:MISS
First Name:GRISELDA
Middle Name:
Last Name:LEAL-TEJADA
Suffix:
Gender:F
Credentials:SUDRC I
Other - Prefix:MISS
Other - First Name:GRISELDA
Other - Middle Name:
Other - Last Name:LEAL-TEJADA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1827 LOGAN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92113-2135
Mailing Address - Country:US
Mailing Address - Phone:619-326-6929
Mailing Address - Fax:
Practice Address - Street 1:4930 NAPLES ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-3820
Practice Address - Country:US
Practice Address - Phone:619-269-8969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-29
Last Update Date:2025-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22474101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)