Provider Demographics
NPI:1609369115
Name:DE FREITAS, PEDRO HENRIQUE (FNP)
Entity Type:Individual
Prefix:
First Name:PEDRO
Middle Name:HENRIQUE
Last Name:DE FREITAS
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2479 MAYWOOD LN
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96003-7343
Mailing Address - Country:US
Mailing Address - Phone:305-726-5803
Mailing Address - Fax:
Practice Address - Street 1:9461 DESCHUTES RD STE 4
Practice Address - Street 2:
Practice Address - City:PALO CEDRO
Practice Address - State:CA
Practice Address - Zip Code:96073-9761
Practice Address - Country:US
Practice Address - Phone:530-547-5305
Practice Address - Fax:563-547-4110
Is Sole Proprietor?:No
Enumeration Date:2018-06-08
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95009186207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine