Provider Demographics
NPI:1982349759
Name:LEDESMA ESTUPINAN, DELFINA LILIA
Entity type:Individual
Prefix:
First Name:DELFINA
Middle Name:LILIA
Last Name:LEDESMA ESTUPINAN
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 1:139 MARINER LN
Mailing Address - Street 2:
Mailing Address - City:ROTONDA WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33947-2025
Mailing Address - Country:US
Mailing Address - Phone:786-234-4618
Mailing Address - Fax:
Practice Address - Street 1:5051 MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-7355
Practice Address - Country:US
Practice Address - Phone:813-290-0779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-04
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
FL1-21-51732103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1-21-51732OtherBCBA
FL118829400Medicaid