Provider Demographics
NPI:1720878366
Name:LEDESMA HUAPAYA, ELSA A
Entity type:Individual
Prefix:
First Name:ELSA
Middle Name:A
Last Name:LEDESMA HUAPAYA
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 1:246 ALDER ST APT B
Mailing Address - Street 2:
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-3147
Mailing Address - Country:US
Mailing Address - Phone:415-328-9486
Mailing Address - Fax:
Practice Address - Street 1:424 VIA HIDALGO
Practice Address - Street 2:
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-1739
Practice Address - Country:US
Practice Address - Phone:415-328-9486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-07
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA154637106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist