Provider Demographics
NPI:1164669396
Name:PEDIGO, LAURA K (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:K
Last Name:PEDIGO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12625 LA MIRADA BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90639-0001
Mailing Address - Country:US
Mailing Address - Phone:562-903-4800
Mailing Address - Fax:562-903-4802
Practice Address - Street 1:12625 LA MIRADA BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:LA MIRADA
Practice Address - State:CA
Practice Address - Zip Code:90639-0001
Practice Address - Country:US
Practice Address - Phone:562-903-4800
Practice Address - Fax:562-903-4802
Is Sole Proprietor?:No
Enumeration Date:2009-01-09
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95-0549600103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist