MEDICARE: LEONOR HUDDLESTON NURSE PRACTITIONER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	364SF0001X	Family Health Clinical Nurse Specialist	95004163	CA

General Provider Information

NPI Number	:	1366899742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEONOR HUDDLESTON NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	6000 N FIGUEROA ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90042-4232
Country	:	US
Telephone Number	:	323-254-5291
Fax Number	:	323-254-4618

Provider Business Practice Location Address
First Line	:	3324 W SUNSET BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90026-2118
Country	:	US
Telephone Number	:	323-660-2400
Fax Number	:	323-661-4375

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2016
Last Update Date	:	12/08/2021

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