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General NPI Number Information
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NPI Number | 1285382929
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Entity Type | Individual
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Provider Name | MICHELLE LOOSS LEDESMA MD
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Gender | Female
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Dates
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Enumeration Date | 03/11/2022
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Last Update Date | 08/28/2023
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Provider Practice Location Address
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Address Line | MANSION DEL NORTE ND19 CAMINO DE LA RANADA
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City | TOA BAJA
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State | PR
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Zip | 00949
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Country | US
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Telephone | 787-201-9183
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Fax |
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Provider Business Mailing Address
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Address Line | ND19 CAMINO DE LA RANADA MANSION DEL NORTE
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City | TOA BAJA
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State | PR
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Zip | 00949-0923
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Country | US
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Telephone | 787-201-9183
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 23445
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License Number State | PR
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