Healthcare Provider Details

I. General information

NPI: 1629056981
Provider Name (Legal Business Name): PAUL VILLANUEVA LEDESMA D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 10/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4921 E BELL RD STE 205
SCOTTSDALE AZ
85254-6002
US

IV. Provider business mailing address

4921 E BELL RD STE 205
SCOTTSDALE AZ
85254-6002
US

V. Phone/Fax

Practice location:
  • Phone: 602-753-9403
  • Fax: 602-753-9453
Mailing address:
  • Phone: 602-753-9403
  • Fax: 602-753-9453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number0695
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number0695
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: