Provider Demographics
NPI:1902197619
Name:LEDESMA, MARCOS (LMT)
Entity Type:Individual
Prefix:
First Name:MARCOS
Middle Name:
Last Name:LEDESMA
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8660 W FLAGLER ST
Mailing Address - Street 2:#203
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-2031
Mailing Address - Country:US
Mailing Address - Phone:305-392-0598
Mailing Address - Fax:866-817-4696
Practice Address - Street 1:8660 W FLAGLER ST
Practice Address - Street 2:#203
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2031
Practice Address - Country:US
Practice Address - Phone:305-392-0598
Practice Address - Fax:866-817-4696
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-28
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA44953225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist