Provider Demographics
NPI:1366899742
Name:HUDDLESTON, LEONOR (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:LEONOR
Middle Name:
Last Name:HUDDLESTON
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6000 N FIGUEROA ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90042-4232
Mailing Address - Country:US
Mailing Address - Phone:323-254-5291
Mailing Address - Fax:323-254-4618
Practice Address - Street 1:3324 W SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90026-2118
Practice Address - Country:US
Practice Address - Phone:323-660-2400
Practice Address - Fax:323-661-4375
Is Sole Proprietor?:No
Enumeration Date:2016-05-16
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95004163364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health