Provider Demographics
NPI:1508478090
Name:LEDUFF SPENCER, SHARON (CERTIFIED HAIR LOSS)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:LEDUFF SPENCER
Suffix:
Gender:F
Credentials:CERTIFIED HAIR LOSS
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:
Other - Last Name:LEDUFF BARKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:148 GITANO
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-1115
Mailing Address - Country:US
Mailing Address - Phone:949-241-5625
Mailing Address - Fax:
Practice Address - Street 1:17942 SKY PARK CIR STE D
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-4429
Practice Address - Country:US
Practice Address - Phone:714-505-2711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAKK2062461744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty