Provider Demographics
NPI:1306321872
Name:LEDESMA, VICKY ELENA
Entity type:Individual
Prefix:
First Name:VICKY
Middle Name:ELENA
Last Name:LEDESMA
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:VICKY
Other - Middle Name:ELENA
Other - Last Name:LEDESMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RODRIGUEZ
Mailing Address - Street 1:251 GRAND CYPRESS AVE
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551
Mailing Address - Country:US
Mailing Address - Phone:661-789-1200
Mailing Address - Fax:
Practice Address - Street 1:251 GRAND CYPRESS AVE
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551
Practice Address - Country:US
Practice Address - Phone:661-789-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-01
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator