Provider Demographics
NPI:1619569902
Name:PEDRAZA-WATSON, ANGGIE PAOLA
Entity Type:Individual
Prefix:
First Name:ANGGIE
Middle Name:PAOLA
Last Name:PEDRAZA-WATSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11303 GOLDEN RAY DR
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-3092
Mailing Address - Country:US
Mailing Address - Phone:760-547-4659
Mailing Address - Fax:
Practice Address - Street 1:25510 TOMBALL PKWY
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-7730
Practice Address - Country:US
Practice Address - Phone:713-306-7061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-08
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX82393101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty