Provider Demographics
NPI:1467993279
Name:LEDEZMA, JOSE RAMON (CPOA CFO)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:RAMON
Last Name:LEDEZMA
Suffix:
Gender:M
Credentials:CPOA CFO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75150 SHERYL AVE STE A
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-5118
Mailing Address - Country:US
Mailing Address - Phone:760-216-3009
Mailing Address - Fax:760-772-3904
Practice Address - Street 1:75150 SHERYL AVE STE A
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-5118
Practice Address - Country:US
Practice Address - Phone:760-216-3009
Practice Address - Fax:760-772-3904
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-13
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier