Individual
GRISELLE VILLAR LEDESMA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
10427 CORONA AVE, CORONA, NY 11368-2979
(718) 592-3458
Mailing address
104-27 CORONA AVE, CORONA, NY 11368
(718) 592-3458
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
018582-1
NY
Other
Enumeration date
05/22/2015
Last updated
09/29/2015
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