Provider Demographics
NPI:1902178171
Name:LADAPO, FELICIA BARBRETTE
Entity Type:Individual
Prefix:
First Name:FELICIA
Middle Name:BARBRETTE
Last Name:LADAPO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:FELICIA
Other - Middle Name:BAEBRETTE
Other - Last Name:TURNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10414 S VAN NESS AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90047-4357
Mailing Address - Country:US
Mailing Address - Phone:323-404-7696
Mailing Address - Fax:
Practice Address - Street 1:5436 S BROADWAY
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90037-4126
Practice Address - Country:US
Practice Address - Phone:323-234-6261
Practice Address - Fax:323-234-6265
Is Sole Proprietor?:No
Enumeration Date:2012-02-03
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA01-094375171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator