MEDICARE: MS. LETICIA ANNE METALLO NP

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	363LA2100X	Acute Care Nurse Practitioner	334836	CA

General Provider Information

NPI Number	:	1912941543
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LETICIA ANNE METALLO NP

Provider Business Mailing Address
First Line	:	6400 CRESCENT PARK EAST
Second Line	:	# 128
City	:	LOS ANGELES
State	:	CA
Zip	:	90094
Country	:	US
Telephone Number	:	310-478-3711
Fax Number	:

Provider Business Practice Location Address
First Line	:	6400 CRESCENT ST
Second Line	:	#128
City	:	LOS ANGELES
State	:	CA
Zip	:	90042-2826
Country	:	US
Telephone Number	:	310-478-3711
Fax Number	:

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

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	07/08/2007

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