Healthcare Provider Details

I. General information

NPI: 1114649878
Provider Name (Legal Business Name): ELIDA M. LEDESMA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2022
Last Update Date: 06/20/2026
Certification Date: 06/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18505 JAVA AVE
LEMOORE CA
93245-9733
US

IV. Provider business mailing address

18505 JAVA AVE
LEMOORE CA
93245-9733
US

V. Phone/Fax

Practice location:
  • Phone: 559-572-5160
  • Fax:
Mailing address:
  • Phone: 855-343-1057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT156239
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: