Provider Demographics
NPI:1154738599
Name:DIAZ LEDEZMA, CLAUDIO
Entity type:Individual
Prefix:
First Name:CLAUDIO
Middle Name:
Last Name:DIAZ LEDEZMA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1422 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-3807
Mailing Address - Country:US
Mailing Address - Phone:415-613-2113
Mailing Address - Fax:
Practice Address - Street 1:1500 OWENS ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94158-2334
Practice Address - Country:US
Practice Address - Phone:415-353-2509
Practice Address - Fax:415-353-2956
Is Sole Proprietor?:No
Enumeration Date:2014-07-17
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD450697207XS0114X
CASPI805207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery