Letia Bogan

Individual provider Active NPI Peer Specialist · Ridgecrest, CA

NPI 1679244693 · NPPES record last updated Sep 21, 2021

Key facts

NPI
1679244693
Entity type
Individual (NPI type 1)
Primary specialty
Peer Specialist 175T00000X
Practice address
1400 N Norma St Ste 133
Ridgecrest, CA 93555-2577
Phone
(760) 499-7406
NPI assigned
Sep 21, 2021
Sex
Female
Sole proprietor
No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

Practice roles

OrganizationSpecialtyStatusNew patients
College Community Services Past
since Sep 28, 2021
Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Peer Specialist 175T00000X Yes

Addresses

Primary practice location

1400 N Norma St Ste 133
Ridgecrest, CA 93555-2577

Mailing address

1400 N Norma St Ste 133
Ridgecrest, CA 93555-2577
Phone (760) 499-7406

Other providers in Ridgecrest, CA

All providers in Ridgecrest, CA · Peer Specialist in California

Sources for this page

Verify at the official NPI Registry.