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General NPI Number Information
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NPI Number | 1487336756
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Entity Type | Individual
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Provider Name | JOSE ANDRES LEDEZMA CERVANTES
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Gender | Male
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Dates
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Enumeration Date | 08/04/2023
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Last Update Date | 11/07/2023
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Provider Practice Location Address
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Address Line | 5588 N PALM AVE
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City | FRESNO
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State | CA
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Zip | 93704-1913
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Country | US
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Telephone | 559-365-6559
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Fax |
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Provider Business Mailing Address
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Address Line | 41389 ROAD 130
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City | OROSI
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State | CA
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Zip | 93647-2277
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Country | US
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Telephone | 559-429-9187
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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