Healthcare Provider Details

I. General information

NPI: 1548239932
Provider Name (Legal Business Name): LEAH GAIL HOPKINS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 03/04/2022
Certification Date: 03/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4646 BROCKTON AVE SUITE 201
RIVERSIDE CA
92506
US

IV. Provider business mailing address

4646 BROCKTON AVE SUITE 201
RIVERSIDE CA
92506
US

V. Phone/Fax

Practice location:
  • Phone: 951-585-1800
  • Fax: 951-585-1801
Mailing address:
  • Phone: 951-585-1800
  • Fax: 951-585-1801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35.123499
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number21316
License Number StateWV
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC156195
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: