Provider Demographics
NPI:1114578937
Name:PEDRAZA, ALBERTO (FNP-C)
Entity Type:Individual
Prefix:
First Name:ALBERTO
Middle Name:
Last Name:PEDRAZA
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4050 NORTHRISE DR
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-7327
Mailing Address - Country:US
Mailing Address - Phone:575-652-3040
Mailing Address - Fax:575-652-3093
Practice Address - Street 1:211 BARTLETT DR STE 102
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-1607
Practice Address - Country:US
Practice Address - Phone:915-745-8633
Practice Address - Fax:915-745-8632
Is Sole Proprietor?:No
Enumeration Date:2019-09-23
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP142896363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily