Provider Demographics
NPI:1912177494
Name:LEDEZMA, BEATRIZ E
Entity Type:Individual
Prefix:MS
First Name:BEATRIZ
Middle Name:E
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:PO BOX 151240
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92116
Mailing Address - Country:US
Mailing Address - Phone:619-278-2402
Mailing Address - Fax:619-294-9205
Practice Address - Street 1:3990 OLD TOWN AVE
Practice Address - Street 2:SUITE C 201
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110
Practice Address - Country:US
Practice Address - Phone:619-278-2703
Practice Address - Fax:619-294-9405
Is Sole Proprietor?:No
Enumeration Date:2008-03-11
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator