Individual provider Active NPI

Maricela Ledezma, PA-C

  • Physician Assistant
  • Porterville, CA
National Provider Identifier
1316433469
Registry record updated Jul 2, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
55676 Issued in CA
Practice address
1107 W Poplar Ave
Porterville, CA 93257-5839
Phone
(877) 960-3426
NPI assigned
Jul 2, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 55676 CA Primary

Addresses

Primary practice location

1107 W Poplar Ave
Porterville, CA 93257-5839

Mailing address

1701 E la Habra Blvd Apt 24
La Habra, CA 90631-4963
Phone (562) 242-8303

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180911003746 CA Practitioner - Physician Assistant 4981954088 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
55676CAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Family Healthcare Network Current Accepting new patients
Family Healthcare Network CurrentSince Aug 6, 2018 Accepting new patients
Family Healthcare Network Current Accepting new patients
Family Healthcare Network Current Accepting new patients
Family Healthcare Network Current Accepting new patients
Family Healthcare Network CurrentSince Aug 6, 2018 Accepting new patients
Family Healthcare Network Current Accepting new patients

Locations

1107 W Poplar Ave
Porterville, CA 93257
Phone (559) 781-7242

305 E Center Ave
Visalia, CA 93291
Phone (559) 737-4792

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/CCECCA

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1530489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1530489600000",
    "number": "1316433469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1701 E LA HABRA BLVD APT 24",
            "city": "LA HABRA",
            "state": "CA",
            "postal_code": "906314963",
            "telephone_number": "562-242-8303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1107 W POPLAR AVE",
            "city": "PORTERVILLE",
            "state": "CA",
            "postal_code": "932575839",
            "telephone_number": "877-960-3426"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEDEZMA",
        "first_name": "MARICELA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-07-02",
        "last_updated": "2018-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "55676",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Porterville, CA

Sources for this page

Verify at the official NPI Registry.