Provider Demographics
NPI:1164074910
Name:LEDONNE, ISAIAH NIGEL
Entity Type:Individual
Prefix:
First Name:ISAIAH
Middle Name:NIGEL
Last Name:LEDONNE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:746 ADA ST STE 106
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-2676
Mailing Address - Country:US
Mailing Address - Phone:619-628-2444
Mailing Address - Fax:619-628-2445
Practice Address - Street 1:746 ADA ST STE 106
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-2676
Practice Address - Country:US
Practice Address - Phone:619-628-2444
Practice Address - Fax:619-628-2445
Is Sole Proprietor?:No
Enumeration Date:2019-07-11
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator