Healthcare Provider Details

I. General information

NPI: 1902332794
Provider Name (Legal Business Name): NICOLE LEDONNA L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 05/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1629 POLLASKY AVE
CLOVIS CA
93612-2654
US

IV. Provider business mailing address

1693 E SALEM AVE
FRESNO CA
93720-2328
US

V. Phone/Fax

Practice location:
  • Phone: 559-475-9881
  • Fax:
Mailing address:
  • Phone: 559-475-9881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number7812
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: