Healthcare Provider Details

I. General information

NPI: 1609796184
Provider Name (Legal Business Name): MS. BEATRIZ LEIDA LEDEZMA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16350 FILBERT ST
SYLMAR CA
91342-1002
US

IV. Provider business mailing address

1125 TIVOLI LN UNIT 120
SIMI VALLEY CA
93065-1969
US

V. Phone/Fax

Practice location:
  • Phone: 818-364-6885
  • Fax:
Mailing address:
  • Phone: 818-434-3156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number164433
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: