Provider Demographics
NPI:1144085762
Name:LEDESMA, BRAIAN RENE (MD)
Entity type:Individual
Prefix:DR
First Name:BRAIAN
Middle Name:RENE
Last Name:LEDESMA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 NW 10TH AVE APT 1406
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-1033
Mailing Address - Country:US
Mailing Address - Phone:786-944-7158
Mailing Address - Fax:
Practice Address - Street 1:21 AUDUBON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-2275
Practice Address - Country:US
Practice Address - Phone:786-944-7158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-14
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program