Provider Demographics
NPI:1629056981
Name:LEDESMA, PAUL VILLANUEVA (DPM)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:VILLANUEVA
Last Name:LEDESMA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4921 E BELL RD STE 205
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-6002
Mailing Address - Country:US
Mailing Address - Phone:602-753-9403
Mailing Address - Fax:602-753-9453
Practice Address - Street 1:4921 E BELL RD STE 205
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-6002
Practice Address - Country:US
Practice Address - Phone:602-753-9403
Practice Address - Fax:602-753-9453
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-06
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0695213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ2558267OtherUHC
AZ4849526OtherCIGNA
AZ7488740OtherAETNA
AZ1629056981OtherBCBS
AZ487680OtherAHCCCS
P00802418OtherRAILROAD MEDICARE PTAN
AZV06404Medicare UPIN
AZ7488740OtherAETNA
AZ4849526OtherCIGNA
AZ2558267OtherUHC
AZZ133721Medicare PIN