Provider Demographics
NPI:1275173130
Name:PEDROZA GONZALES, OMAR
Entity Type:Individual
Prefix:
First Name:OMAR
Middle Name:
Last Name:PEDROZA GONZALES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6530 GIFFORD DR
Mailing Address - Street 2:
Mailing Address - City:COMMERCE CITY
Mailing Address - State:CO
Mailing Address - Zip Code:80022-3539
Mailing Address - Country:US
Mailing Address - Phone:720-400-3059
Mailing Address - Fax:844-765-7946
Practice Address - Street 1:2490 W 26TH AVE STE 300A
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-5321
Practice Address - Country:US
Practice Address - Phone:800-208-2504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-08
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter