Healthcare Provider Details

I. General information

NPI: 1538094446
Provider Name (Legal Business Name): MA LEDI HAM BARRETTO LOOT PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11900 AVALON BLVD STE 100
LOS ANGELES CA
90061-2867
US

IV. Provider business mailing address

9150 TERALINA CIR
RIVERSIDE CA
92503-5837
US

V. Phone/Fax

Practice location:
  • Phone: 888-783-1883
  • Fax: 888-653-3144
Mailing address:
  • Phone: 623-251-9059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95039928
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: