Healthcare Provider Details

I. General information

NPI: 1639914633
Provider Name (Legal Business Name): MR. RICARDO CELESTINO LEDESMA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2024
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2133 3RD AVE
SEATTLE WA
98121-2385
US

IV. Provider business mailing address

801 SPRING ST APT 2-306
SEATTLE WA
98104-1298
US

V. Phone/Fax

Practice location:
  • Phone: 206-223-3644
  • Fax:
Mailing address:
  • Phone: 808-492-0950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberSWIA.SC.70151001
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: