Provider Demographics
NPI:1750970760
Name:LEDEZMA, JOANA
Entity type:Individual
Prefix:
First Name:JOANA
Middle Name:
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 1:201 WILCREST DR # 6508
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77042-1176
Mailing Address - Country:US
Mailing Address - Phone:713-517-3663
Mailing Address - Fax:
Practice Address - Street 1:11112 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77042-4790
Practice Address - Country:US
Practice Address - Phone:713-458-2871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-14
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician