Provider Demographics
NPI:1235901323
Name:LEDUA, TITILIA
Entity Type:Individual
Prefix:MS
First Name:TITILIA
Middle Name:
Last Name:LEDUA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 FARMERS LN STE 6
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-6742
Mailing Address - Country:US
Mailing Address - Phone:707-889-9505
Mailing Address - Fax:707-852-2113
Practice Address - Street 1:725 FARMERS LN STE 6
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-6742
Practice Address - Country:US
Practice Address - Phone:707-889-9505
Practice Address - Fax:707-852-2113
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-23
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4947000413747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant