Individual provider Active NPI

Coretta T Leduff, LVN

  • Licensed Vocational Nurse
  • Hesperia, CA
National Provider Identifier
1851563092
Registry record updated Aug 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Licensed Vocational NurseTaxonomy code 164X00000X
License
VN 158852 Issued in CA
Practice address
11776 Mariposa Rd # 103
Hesperia, CA 92345-1622
Phone
(760) 956-2462
Fax
(760) 947-9118
NPI assigned
Mar 27, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 9, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Vocational Nurse 164X00000X VN 158852 CA Primary

Addresses

Primary practice location

11776 Mariposa Rd # 103
Hesperia, CA 92345-1622

Mailing address

11776 Mariposa Rd # 103
Hesperia, CA 92345-1622
Phone (760) 956-2462

Other practice location 1

490 W 14th St
Long Beach, CA 90813-2943
Phone (562) 591-8701 ext. 229

Other names 1

  • Coretta T McKinney Former name

Medicare participation

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

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
VN 158852CAMDLicensed Vocational Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Aegis Treatment Centers, LLC PastSince Aug 11, 2024 Accepting new patients

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1206576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723161600000",
    "number": "1851563092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11776 MARIPOSA RD # 103",
            "city": "HESPERIA",
            "state": "CA",
            "postal_code": "923451622",
            "telephone_number": "760-956-2462",
            "fax_number": "760-947-9118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11776 MARIPOSA RD # 103",
            "city": "HESPERIA",
            "state": "CA",
            "postal_code": "923451622",
            "telephone_number": "760-956-2462",
            "fax_number": "760-947-9118"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "490 W 14th St",
            "address_purpose": "LOCATION",
            "city": "Long Beach",
            "state": "CA",
            "postal_code": "908132943",
            "country_code": "US",
            "telephone_number": "562-591-8701 x229",
            "fax_number": "562-591-6841",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LEDUFF",
        "first_name": "CORETTA",
        "middle_name": "T",
        "credential": "LVN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-03-27",
        "last_updated": "2024-08-09",
        "certification_date": "2024-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164X00000X",
            "taxonomy_group": "",
            "desc": "Licensed Vocational Nurse",
            "state": "CA",
            "license": "VN 158852",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CORETTA",
            "last_name": "MCKINNEY",
            "middle_name": "T",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Hesperia, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.