Provider Demographics
NPI:1851332423
Name:HEPOLA, MARIE LENORE (MA)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:LENORE
Last Name:HEPOLA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20911 EARL ST STE 400
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-4355
Mailing Address - Country:US
Mailing Address - Phone:310-370-0007
Mailing Address - Fax:
Practice Address - Street 1:20911 EARL ST STE 400
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4355
Practice Address - Country:US
Practice Address - Phone:310-370-0007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA2535237700000X
CAAU1279231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAU0012790Medicaid