Provider Demographics
NPI:1730189093
Name:DU, LETICIA Y (MD)
Entity type:Individual
Prefix:DR
First Name:LETICIA
Middle Name:Y
Last Name:DU
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 1:41238 MARGARITA RD
Mailing Address - Street 2:#106
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-5552
Mailing Address - Country:US
Mailing Address - Phone:951-506-9392
Mailing Address - Fax:951-506-6171
Practice Address - Street 1:41238 MARGARITA RD
Practice Address - Street 2:#106
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-5552
Practice Address - Country:US
Practice Address - Phone:951-506-9392
Practice Address - Fax:951-506-6171
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-28
Last Update Date:2007-07-08
Deactivation Date:2006-03-22
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
CAA493630208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics