Provider Demographics
NPI:1417577289
Name:ARGUETA, PEDRO ALEXANDER (MPH, RDN)
Entity Type:Individual
Prefix:
First Name:PEDRO
Middle Name:ALEXANDER
Last Name:ARGUETA
Suffix:
Gender:M
Credentials:MPH, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1560 S ARDMORE AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-4327
Mailing Address - Country:US
Mailing Address - Phone:323-215-7255
Mailing Address - Fax:
Practice Address - Street 1:13803 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:SYLMAR
Practice Address - State:CA
Practice Address - Zip Code:91342-3013
Practice Address - Country:US
Practice Address - Phone:818-270-9508
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-22
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86029504133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
86029504OtherCDR