Provider Demographics
NPI:1467763755
Name:PEDREGO, VANESSA C (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:C
Last Name:PEDREGO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:VANESSA
Other - Middle Name:C
Other - Last Name:CASTRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:840 TOWNE CENTER DR
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-5900
Mailing Address - Country:US
Mailing Address - Phone:909-398-1550
Mailing Address - Fax:909-398-1488
Practice Address - Street 1:520 E FOOTHILL BLVD STE A
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-1200
Practice Address - Country:US
Practice Address - Phone:909-622-3065
Practice Address - Fax:909-784-3399
Is Sole Proprietor?:No
Enumeration Date:2010-07-01
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA20983363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant