Provider Demographics
NPI:1487090130
Name:DR JAIME LEDESMA CSP
Entity type:Organization
Organization Name:DR JAIME LEDESMA CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:DR
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:
Authorized Official - Last Name:LEDESMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:939-202-0882
Mailing Address - Street 1:32 PARQ LA ARBOLEDA
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00603-6743
Mailing Address - Country:US
Mailing Address - Phone:939-202-0882
Mailing Address - Fax:
Practice Address - Street 1:URB VILLA ALEGRIA CALLE ZAFIRO 151
Practice Address - Street 2:LOCAL 1B
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00605
Practice Address - Country:US
Practice Address - Phone:939-202-0882
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-21
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16663261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care