Healthcare Provider Details

I. General information

NPI: 1912177494
Provider Name (Legal Business Name): MS. BEATRIZ E LEDEZMA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2008
Last Update Date: 03/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3990 OLD TOWN AVE SUITE C 201
SAN DIEGO CA
92110
US

IV. Provider business mailing address

PO BOX 151240
SAN DIEGO CA
92116
US

V. Phone/Fax

Practice location:
  • Phone: 619-278-2703
  • Fax: 619-294-9405
Mailing address:
  • Phone: 619-278-2402
  • Fax: 619-294-9205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: