Provider Demographics
NPI:1417297037
Name:DENGA, PEDRO
Entity Type:Individual
Prefix:MR
First Name:PEDRO
Middle Name:
Last Name:DENGA
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 1:10139 W. HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037
Mailing Address - Country:US
Mailing Address - Phone:602-795-6245
Mailing Address - Fax:602-795-6245
Practice Address - Street 1:10139 W HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-5223
Practice Address - Country:US
Practice Address - Phone:602-405-5957
Practice Address - Fax:602-441-0057
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-19
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD06542042171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor