| Doctor Name: | LETICIA KOUCHAK-EFTEKHAR |
| NPI Number: | 1114349792 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 414975 |
| Business Practice Address: | 330 W Maple Ave Monrovia, CA - 910163332 |
| Business Phone Number: | 6262561647 |
| Business Fax Number: | |
| Mailing Address: | 25439 Doyle Ct, STEVENSON RANCH |
| State: | CA |
| Postal Code: | 913811550 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 01/15/2014 |
| NPI Last Update Date: | 01/15/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LW0102X |
| License Number: | 414975 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Women's Health |
| Taxonomy Definition: | |