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General NPI Number Information
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NPI Number | 1013487636
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Entity Type | Individual
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Provider Name | CASSONDRA LEDEZMA
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Gender | Female
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Dates
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Enumeration Date | 11/26/2018
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Last Update Date | 08/14/2024
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Provider Practice Location Address
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Address Line | 7702 HAYWOOD PL
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-0365
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Country | US
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Telephone | 760-409-7288
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Fax |
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Provider Business Mailing Address
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Address Line | 1505 DEXTER WAY
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City | REDLANDS
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State | CA
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Zip | 92374-4183
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Country | US
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Telephone | 909-222-5164
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-24-72859
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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