Healthcare Provider Details

I. General information

NPI: 1215219332
Provider Name (Legal Business Name): INGRID LEU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2011
Last Update Date: 02/27/2024
Certification Date: 02/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9808 VENICE BLVD STE 300
CULVER CITY CA
90232-2732
US

IV. Provider business mailing address

9808 VENICE BLVD STE 300
CULVER CITY CA
90232-2732
US

V. Phone/Fax

Practice location:
  • Phone: 310-237-0454
  • Fax:
Mailing address:
  • Phone: 310-237-0454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XM0800X
TaxonomyMental Health Occupational Therapist
License Number13813
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: