Provider Demographics
NPI:1386283885
Name:HUGHES, LA DESHA MARIE (MHW)
Entity type:Individual
Prefix:
First Name:LA DESHA
Middle Name:MARIE
Last Name:HUGHES
Suffix:
Gender:F
Credentials:MHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9288 VIA SEVILLA DR
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90620-4125
Mailing Address - Country:US
Mailing Address - Phone:562-612-6272
Mailing Address - Fax:
Practice Address - Street 1:9288 VIA SEVILLA DR
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90620-4125
Practice Address - Country:US
Practice Address - Phone:562-612-6272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-31
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program