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General NPI Number Information
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NPI Number | 1427818590
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Entity Type | Organization
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Legal Business Name | DOCTOR LETA INC.
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Dates
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Enumeration Date | 03/19/2024
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Last Update Date | 03/19/2024
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Provider Practice Location Address
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Address Line | 3335 MISSION DR
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City | SANTA CRUZ
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State | CA
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Zip | 95065-1827
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Country | US
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Telephone | 831-222-0189
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Fax | 831-428-0101
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Provider Business Mailing Address
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Address Line | 3614 PORTER GULCH RD
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City | APTOS
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State | CA
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Zip | 95003-2708
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Country | US
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Telephone | 831-239-9326
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Fax | 831-428-0101
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Authorized Official
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Title or Position | CEO
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Name | DR. LETA BETH JUSSILA
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Credential | DAOM
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Telephone | 831-239-9326
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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