Healthcare Provider Details

I. General information

NPI: 1801181581
Provider Name (Legal Business Name): LINDA-MICHELLE LEDESMA D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2011
Last Update Date: 11/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3328 N LITCHFIELD RD
GOODYEAR AZ
85395-3198
US

IV. Provider business mailing address

1250 S CLEARVIEW AVE SUITE 100
MESA AZ
85209-3378
US

V. Phone/Fax

Practice location:
  • Phone: 623-239-0394
  • Fax: 623-536-5813
Mailing address:
  • Phone: 480-988-9108
  • Fax: 480-813-4460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number006241
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: