Provider Demographics
NPI:1003043241
Name:PEDRICK, EDNA THEORA
Entity Type:Individual
Prefix:MS
First Name:EDNA
Middle Name:THEORA
Last Name:PEDRICK
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 1:1200 AGUAJITO RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-4887
Mailing Address - Country:US
Mailing Address - Phone:831-647-7652
Mailing Address - Fax:831-647-7940
Practice Address - Street 1:1200 AGUAJITO RD
Practice Address - Street 2:SUITE103
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-4887
Practice Address - Country:US
Practice Address - Phone:831-647-7652
Practice Address - Fax:831-647-7940
Is Sole Proprietor?:No
Enumeration Date:2009-06-15
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other