Healthcare Provider Details

I. General information

NPI: 1447401633
Provider Name (Legal Business Name): CHRISTOPHER LEDLOW PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2008
Last Update Date: 10/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6815 NOBLE AVE
VAN NUYS CA
91405-3796
US

IV. Provider business mailing address

22411 ALAMOTA DR
SAUGUS CA
91350-1543
US

V. Phone/Fax

Practice location:
  • Phone: 818-901-6600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number19977
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: