Provider Demographics
NPI:1154520971
Name:HEAL HOPLEY, LETICIA REBECCA (NP)
Entity type:Individual
Prefix:MS
First Name:LETICIA
Middle Name:REBECCA
Last Name:HEAL HOPLEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1815 GOODMAN AVE
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-2722
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1535 S WESTERN AVE
Practice Address - Street 2:SUITE G
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-4200
Practice Address - Country:US
Practice Address - Phone:323-733-1885
Practice Address - Fax:323-733-1875
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA349769163W00000X
CA10190363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANP10190OtherNURSE PRACTITIONER CERTIF
CARN349769Medicaid
CARN 349769OtherREGISTERED NURSE LIC