Provider Demographics
NPI:1811617624
Name:LEDESMA RIVERA, ISSELINE
Entity type:Individual
Prefix:DR
First Name:ISSELINE
Middle Name:
Last Name:LEDESMA RIVERA
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:URB. PALMAS DE CERRO GORDO
Mailing Address - Street 2:AVENIDA PALMAS 6
Mailing Address - City:VEGA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00692
Mailing Address - Country:US
Mailing Address - Phone:787-593-3035
Mailing Address - Fax:
Practice Address - Street 1:URB. FLAMBOYAN GARDENS
Practice Address - Street 2:CALLE 24 AA3
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-395-7555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-31
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR871111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor