Provider Demographics
NPI:1427818590
Name:DOCTOR LETA INC.
Entity type:Organization
Organization Name:DOCTOR LETA INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:LETA
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:JUSSILA
Authorized Official - Suffix:
Authorized Official - Credentials:DAOM
Authorized Official - Phone:831-239-9326
Mailing Address - Street 1:3614 PORTER GULCH RD
Mailing Address - Street 2:
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95003-2708
Mailing Address - Country:US
Mailing Address - Phone:831-239-9326
Mailing Address - Fax:831-428-0101
Practice Address - Street 1:3335 MISSION DR
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95065-1827
Practice Address - Country:US
Practice Address - Phone:831-222-0189
Practice Address - Fax:831-428-0101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service