MEDICARE: LEONARDO LEDESMA JR. BSN, RN, CEN, LP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	146L00000X	Paramedic	700417	TX
2	163WE0003X	Emergency Registered Nurse	869629	TX
3	163W00000X	Registered Nurse	869629	TX

General Provider Information

NPI Number	:	1295543106
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEONARDO LEDESMA JR. BSN, RN, CEN, LP

Provider Business Mailing Address
First Line	:	10629 SPRINGWOOD DR APT C
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79935-3155
Country	:	US
Telephone Number	:	210-843-8630
Fax Number	:

Provider Business Practice Location Address
First Line	:	3637 MATTOX ST
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79925-1307
Country	:	US
Telephone Number	:	915-303-8020
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/23/2024
Last Update Date	:	12/23/2024

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