Provider Demographics
NPI:1811627185
Name:LEDESMA, BRYAN (ND)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:
Last Name:LEDESMA
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1573
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92702-1573
Mailing Address - Country:US
Mailing Address - Phone:714-787-9594
Mailing Address - Fax:
Practice Address - Street 1:833 N VAN NESS AVE
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-3321
Practice Address - Country:US
Practice Address - Phone:714-787-9594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-10
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND1316175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath