Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 16286 | AZ |
NPI | 1073618161 |
---|---|
Provider Name | Jaime M Ledesma |
First Address | Tucson, AZ 85751-1235 |
Second Address | Tucson, AZ 85704-4447 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2006 |
Last Update Date | 12/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
285503 | (05) | AZ |
C97922 | (02) | AZ |