Healthcare Provider Details

I. General information

NPI: 1164018826
Provider Name (Legal Business Name): LEADING PUBLIC HEALTH ENTERPRISES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2020
Last Update Date: 12/17/2020
Certification Date: 12/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8732 S SEPULVEDA BLVD FL 2
LOS ANGELES CA
90045-4031
US

IV. Provider business mailing address

400 CORPORATE POINTE STE 300
CULVER CITY CA
90230-7620
US

V. Phone/Fax

Practice location:
  • Phone: 831-200-2774
  • Fax: 323-968-0006
Mailing address:
  • Phone: 831-200-3774
  • Fax: 323-968-0006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateNULL

VIII. Authorized Official

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