MEDICARE: LEADING PUBLIC HEALTH ENTERPRISES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	103TC0700X	Clinical Psychologist
2	225700000X	Massage Therapist
3	363A00000X	Physician Assistant
4	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1164018826
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEADING PUBLIC HEALTH ENTERPRISES, INC.

Provider Business Mailing Address
First Line	:	400 CORPORATE POINTE STE 300
Second Line	:
City	:	CULVER CITY
State	:	CA
Zip	:	90230-7620
Country	:	US
Telephone Number	:	831-200-3774
Fax Number	:	323-968-0006

Provider Business Practice Location Address
First Line	:	8732 S SEPULVEDA BLVD FL 2
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-4031
Country	:	US
Telephone Number	:	831-200-2774
Fax Number	:	323-968-0006

Authorized Official
Title or Position	:	CHIEF OPERATING OFFICER
Name	:	DR. JESSICA SAINT-PAUL
Credential	:	DMSC, PA, MPH
Telephone Number	:	831-200-3774

Provider Enumeration Date	:	12/17/2020
Last Update Date	:	12/17/2020

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