Provider Demographics
NPI:1871206342
Name:LEDO PEREZ, EMILIA MARIA
Entity type:Individual
Prefix:
First Name:EMILIA
Middle Name:MARIA
Last Name:LEDO PEREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14510 BALDWIN PARK TOWNE CTR STE G1
Mailing Address - Street 2:
Mailing Address - City:BALDWIN PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91706-5549
Mailing Address - Country:US
Mailing Address - Phone:786-901-0319
Mailing Address - Fax:
Practice Address - Street 1:14510 BALDWIN PARK TOWNE CTR STE G1
Practice Address - Street 2:
Practice Address - City:BALDWIN PARK
Practice Address - State:CA
Practice Address - Zip Code:91706-5549
Practice Address - Country:US
Practice Address - Phone:786-901-0319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-29
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA108427122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist