Basic Information
Provider Information
NPI: 1114020484
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HOPKINS
FirstName: LEAH
MiddleName: L
NamePrefix:  
NameSuffix:  
Credential: M.S., R.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: P O BOX HH
Address2: BUSINESS DEVELOPMENT & CONTRACTING
City: MONTEREY
State: CA
PostalCode: 99342
CountryCode: US
TelephoneNumber: 8316222716
FaxNumber: 8316254764
Practice Location
Address1: 23625 WR HOLMAN HIGHWAY
Address2:  
City: MONTEREY
State: CA
PostalCode: 93940
CountryCode: US
TelephoneNumber: 8316245311
FaxNumber: 8316254948
Other Information
ProviderEnumerationDate: 09/05/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
133V00000XRD714406CAY Dietary & Nutritional Service ProvidersDietitian, Registered 

No ID Information.


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