Healthcare Provider Details

I. General information

NPI: 1235064288
Provider Name (Legal Business Name): PETRA HOPKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41769 11TH STREET WEST, UNIT A
PALMDALE CA
93551-1418
US

IV. Provider business mailing address

45724 BERKSHIRE ST
LANCASTER CA
93534-5103
US

V. Phone/Fax

Practice location:
  • Phone: 661-947-9554
  • Fax: 661-947-9337
Mailing address:
  • Phone: 661-524-3528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: