Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | MD450697 | PA |
NPI | 1154738599 |
---|---|
Provider Name | Claudio Diaz Ledezma |
First Address | Philadelphia, PA 19106-3914 |
Second Address | Philadelphia, PA 19106-3914 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2014 |
Last Update Date | 17/07/2014 |