Healthcare Provider Details

I. General information

NPI: 1740659994
Provider Name (Legal Business Name): AURORA CASAS LEDEZMA PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2015
Last Update Date: 09/06/2023
Certification Date: 09/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1282 W ARROW HWY # 100
UPLAND CA
91786-5040
US

IV. Provider business mailing address

PO BOX 1481
RIALTO CA
92377
US

V. Phone/Fax

Practice location:
  • Phone: 909-931-4034
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: