Healthcare Provider Details

I. General information

NPI: 1356185359
Provider Name (Legal Business Name): JESSICA LEDUFF
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2024
Last Update Date: 06/24/2024
Certification Date: 06/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3111 N TUSTIN ST STE 180
ORANGE CA
92865-1752
US

IV. Provider business mailing address

6600 WARNER AVE UNIT 182
HUNTINGTON BEACH CA
92647-5273
US

V. Phone/Fax

Practice location:
  • Phone: 714-282-7701
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number6878
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: