Provider Demographics
NPI:1518630904
Name:LEDEZMA, JOEL RONNIE
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:RONNIE
Last Name:LEDEZMA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 W TERESA ST
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-1714
Mailing Address - Country:US
Mailing Address - Phone:541-243-4116
Mailing Address - Fax:
Practice Address - Street 1:1005 W TERESA ST
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-1714
Practice Address - Country:US
Practice Address - Phone:541-243-4116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-30
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner