Healthcare Provider Details

I. General information

NPI: 1154738599
Provider Name (Legal Business Name): CLAUDIO DIAZ LEDEZMA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2014
Last Update Date: 04/10/2025
Certification Date: 04/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 OWENS ST
SAN FRANCISCO CA
94158-2334
US

IV. Provider business mailing address

1422 5TH AVE
SAN FRANCISCO CA
94122-3807
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-2509
  • Fax: 415-353-2956
Mailing address:
  • Phone: 415-613-2113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License NumberMD450697
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License NumberSPI805
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: