Provider Demographics
NPI:1497712012
Name:HUMPHREY, HELENA CHARLETTE (MD)
Entity Type:Individual
Prefix:DR
First Name:HELENA
Middle Name:CHARLETTE
Last Name:HUMPHREY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7872 WALKER ST STE 100
Mailing Address - Street 2:
Mailing Address - City:LA PALMA
Mailing Address - State:CA
Mailing Address - Zip Code:90623-1748
Mailing Address - Country:US
Mailing Address - Phone:714-522-4009
Mailing Address - Fax:714-670-6984
Practice Address - Street 1:7872 WALKER ST
Practice Address - Street 2:SUITE 100
Practice Address - City:LA PALMA
Practice Address - State:CA
Practice Address - Zip Code:90623-1796
Practice Address - Country:US
Practice Address - Phone:714-522-4009
Practice Address - Fax:714-670-6984
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG56018207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G560180Medicaid
CAG56018OtherLICENSE
CABH0165200OtherDEA
CAA53073Medicare UPIN
CAPENDINGMedicare PIN