Provider Demographics
NPI:1710066147
Name:LEDUC, XUANTO (MD)
Entity Type:Individual
Prefix:
First Name:XUANTO
Middle Name:
Last Name:LEDUC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11160 WARNER AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-4010
Mailing Address - Country:US
Mailing Address - Phone:714-540-0105
Mailing Address - Fax:714-540-6727
Practice Address - Street 1:11160 WARNER AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-4010
Practice Address - Country:US
Practice Address - Phone:714-540-0105
Practice Address - Fax:714-540-6727
Is Sole Proprietor?:No
Enumeration Date:2006-11-05
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA39058207SG0201X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A390581Medicaid
CA00A390581Medicaid
A85227Medicare UPIN