Healthcare Provider Details

I. General information

NPI: 1245992635
Provider Name (Legal Business Name): LERONICA BEDFORD NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2021
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3576 ARLINGTON AVE STE 205
RIVERSIDE CA
92506-3984
US

IV. Provider business mailing address

27260 LOS ALTOS APT 1214
MISSION VIEJO CA
92691-8507
US

V. Phone/Fax

Practice location:
  • Phone: 951-530-8972
  • Fax:
Mailing address:
  • Phone: 714-363-2203
  • Fax: 949-522-7009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95017715
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95017715
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: