Provider Demographics
NPI:1588848022
Name:LEDEZMA, MARY ELIZABETH
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:ELIZABETH
Last Name:LEDEZMA
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 1:924 N COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85201-4108
Mailing Address - Country:US
Mailing Address - Phone:480-969-3800
Mailing Address - Fax:
Practice Address - Street 1:4250 E FLORIAN AVE
Practice Address - Street 2:BUILDING 1
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-2797
Practice Address - Country:US
Practice Address - Phone:480-844-1653
Practice Address - Fax:480-539-4947
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-19
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program